Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/130130
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Type: | Journal article |
Title: | Long-term cost-effectiveness of a disease management program for patients with atrial fibrillation compared to standard care–a multi-state survival model based on a randomized controlled trial |
Author: | Gao, L. Scuffham, P. Ball, J. Stewart, S. Byrnes, J. |
Citation: | Journal of Medical Economics, 2021; 24(1):87-95 |
Publisher: | Taylor & Francis |
Issue Date: | 2021 |
ISSN: | 1369-6998 1941-837X |
Statement of Responsibility: | Lan Gao, Paul Scuffham, Jocasta Ball, Simon Stewart and Joshua Byrnes |
Abstract: | Aim: To assess the long-term cost-effectiveness of an atrial fibrillation disease management program (i.e. the SAFETY program) from the Australian healthcare system perspective. Methods: A multistate Markov model was developed based on patient-level data from the SAFETY randomized controlled trial. Predicted long-term survival, dependent on hospital admission history, was estimated by extrapolating parametric survival models. Quality-adjusted life years (QALY) and life years (LY) were the primary and secondary outcome measures used to estimate the incremental cost-utility/effectiveness ratio (ICUR/ICER). Both deterministic and probabilistic sensitivity analyses (PSA) were undertaken. Results: The SAFETY program was associated with both higher costs ($94,953 vs. $78,433) and benefits [QALY (3.99 vs 3.60); LY (5.86 vs 5.24)], with an ICUR of $42,513/QALY or ICER of $26,356/LY, compared to standard care. Due to the extended survival, the SAFETY was associated with a greater number of hospitalizations (14.85 vs 11.65) and higher costs for medications ($25,084 vs $22,402) and outpatient care ($12,904 vs $11,524). The cost per hospitalization for an average length of stay, analytical time horizon, and cost of medication are key determinants of ICUR. The PSA showed that the intervention has a 70.4% probability of being cost-effective at a threshold of $50,000/QALY. Conclusions: The SAFETY program has a high probability of being cost-effective for patients with atrial fibrillation. It is associated with uncertainty that further research could potentially eliminate; implementation with further evidence collection is recommended. |
Keywords: | Atrial fibrillation I13 I18 Markov model cost-effectiveness analysis nurse-coordinated multidisciplinary program |
Rights: | 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. |
DOI: | 10.1080/13696998.2020.1860371 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/519823 |
Published version: | http://dx.doi.org/10.1080/13696998.2020.1860371 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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hdl_130130.pdf | Published version | 2.29 MB | Adobe PDF | View/Open |
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