Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

J.M.L. Hendriks, F. Tomini, A.D.I. van Asselt, H.J.G.M. Crijns, H.J.M. Vrijhoef

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Aims
A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiveness of this nurse-led care programme vs. usual care.
Methods and results
A cost-effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline-adherent management, steered by dedicated software, supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per life-year and a cost per quality-adjusted life-year (QALY) analysis was performed, both from a hospital perspective. The nurse-led care programme was associated with slightly more life-years and QALYs at a lower cost. Specifically, the nurse-led programme contributed to 0.009 QALY gains with a reduced cost of €1109 per patient and a gain of 0.02 life-years with a reduced cost of €735 per patient. Therefore, the nurse-led programme would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led programme is considered to be more likely cost-effective than the care as usual.
Conclusion
The cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach will save costs and improve survival and quality of life, and is therefore a cost-effective management strategy for patients with AF.
Keywords: Atrial fibrillation, Outpatient care, Adherence to guidelines, Cardiovascular hospitalization and death, Nursing, Cost-effectiveness
Original languageEnglish
Pages (from-to)1128-1135
JournalEuropace
Volume15
Issue number8
DOIs
Publication statusPublished - 2013

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Cost-Benefit Analysis
Nurses
Quality-Adjusted Life Years
Guideline Adherence
Netherlands

Cite this

Hendriks, J. M. L., Tomini, F., van Asselt, A. D. I., Crijns, H. J. G. M., & Vrijhoef, H. J. M. (2013). Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation. Europace, 15(8), 1128-1135. https://doi.org/10.1093/europace/eut055
Hendriks, J.M.L. ; Tomini, F. ; van Asselt, A.D.I. ; Crijns, H.J.G.M. ; Vrijhoef, H.J.M. / Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation. In: Europace. 2013 ; Vol. 15, No. 8. pp. 1128-1135.
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Hendriks, JML, Tomini, F, van Asselt, ADI, Crijns, HJGM & Vrijhoef, HJM 2013, 'Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation', Europace, vol. 15, no. 8, pp. 1128-1135. https://doi.org/10.1093/europace/eut055

Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation. / Hendriks, J.M.L.; Tomini, F.; van Asselt, A.D.I.; Crijns, H.J.G.M.; Vrijhoef, H.J.M.

In: Europace, Vol. 15, No. 8, 2013, p. 1128-1135.

Research output: Contribution to journalArticleScientificpeer-review

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AU - Hendriks, J.M.L.

AU - Tomini, F.

AU - van Asselt, A.D.I.

AU - Crijns, H.J.G.M.

AU - Vrijhoef, H.J.M.

PY - 2013

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N2 - AimsA recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiveness of this nurse-led care programme vs. usual care.Methods and resultsA cost-effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline-adherent management, steered by dedicated software, supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per life-year and a cost per quality-adjusted life-year (QALY) analysis was performed, both from a hospital perspective. The nurse-led care programme was associated with slightly more life-years and QALYs at a lower cost. Specifically, the nurse-led programme contributed to 0.009 QALY gains with a reduced cost of €1109 per patient and a gain of 0.02 life-years with a reduced cost of €735 per patient. Therefore, the nurse-led programme would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led programme is considered to be more likely cost-effective than the care as usual.ConclusionThe cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach will save costs and improve survival and quality of life, and is therefore a cost-effective management strategy for patients with AF.Keywords: Atrial fibrillation, Outpatient care, Adherence to guidelines, Cardiovascular hospitalization and death, Nursing, Cost-effectiveness

AB - AimsA recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiveness of this nurse-led care programme vs. usual care.Methods and resultsA cost-effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline-adherent management, steered by dedicated software, supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per life-year and a cost per quality-adjusted life-year (QALY) analysis was performed, both from a hospital perspective. The nurse-led care programme was associated with slightly more life-years and QALYs at a lower cost. Specifically, the nurse-led programme contributed to 0.009 QALY gains with a reduced cost of €1109 per patient and a gain of 0.02 life-years with a reduced cost of €735 per patient. Therefore, the nurse-led programme would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led programme is considered to be more likely cost-effective than the care as usual.ConclusionThe cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach will save costs and improve survival and quality of life, and is therefore a cost-effective management strategy for patients with AF.Keywords: Atrial fibrillation, Outpatient care, Adherence to guidelines, Cardiovascular hospitalization and death, Nursing, Cost-effectiveness

U2 - 10.1093/europace/eut055

DO - 10.1093/europace/eut055

M3 - Article

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SP - 1128

EP - 1135

JO - Europace

JF - Europace

SN - 1099-5129

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ER -