Rapid Access Atrial Fibrillation Clinics in Australia - Modelling outcomes and cost effectiveness
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Aims
Stroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but clinical outcomes and cost-effectiveness of them are uncertain. This study aimed to perform a cost-effectiveness evaluation of a RAAF clinic within a large regional health service in Australia.
Methods
We developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022-2023. Clinic data was used to determine risk of stroke, major bleeding, and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a two-year time horizon, with individuals replicated 1,000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALY) and healthcare costs for the RAAF compared to standard of care, which were used to determine incremental cost-effectiveness ratios (ICER), with 5% annual discounting
Results
The RAAF clinic participants experienced fewer strokes (5,198 vs 5,303), bleeding events (5,369 vs 5,491) and deaths (14,158 vs 14,413). There were marginal increases in QALYs gained (1.67 vs. 1.66 QALY/person), and cost savings of $74 per person ($14,187 vs $14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.
Conclusion
RAAF clinics are likely to prevent strokes, bleeding, and are cost-saving and could lead to returns on investment. Adoption of this model of care by policy makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding, and death in people with atrial fibrillation.
