Rapid Access Atrial Fibrillation Clinics in Australia - Modelling Outcomes and Cost-Effectiveness.

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2026-04-30 DOI:10.1007/s40256-026-00796-7

Adam C Livori, Ansu Alex, Tamrat Abebe, J Simon Bell, Zanfina Ademi, Jedidiah I Morton

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引用次数: 0

Abstract

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 their clinical outcomes and cost-effectiveness are uncertain. This study aimed to perform a cost-effectiveness evaluation, from a healthcare system perspective, of an 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 and 2023. Clinic data were 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 2-year time horizon, with individuals replicated 1000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALYs) and healthcare costs for the RAAF compared with 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 (5198 versus 5303), bleeding events (5369 versus 5491) and deaths (14,158 versus 14,413). There were marginal increases in QALYs gained (1.67 versus 1.66 QALYs/person), and cost savings of AUD$74 per person (AUD$14,187 versus AUD$14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.

Conclusions: RAAF clinics are likely to prevent strokes and bleeding, 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.

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快速进入房颤诊所在澳大利亚-模拟结果和成本效益。

目的：房颤（AF）患者的卒中预防需要评估风险并在指征时开始抗凝治疗。快速获取心房颤动（RAAF）诊所是一种公认的多学科治疗模式，可减少卒中风险时间，但其临床结果和成本效益尚不确定。本研究旨在执行成本效益评估，从医疗保健系统的角度来看，在澳大利亚的一个大型区域卫生服务RAAF诊所。方法：我们建立了一个微观模拟模型，使用了2022年至2023年间在RAAF诊所就诊的274名个体。临床数据被用来根据GARFIELD方程确定中风、大出血和死亡的风险。通过重复队列并改变从转诊到同一卫生服务（即标准护理）内普通心脏病诊所咨询的时间来设计比较国。该模型在2年的时间范围内每天循环运行，从274个初始队列中复制了1000个个体。结果是卒中、出血事件、质量调整生命年（QALYs）和与标准护理相比较的RAAF的医疗费用，这些用于确定增量成本-效果比（ICER），每年有5%的折扣。结果：RAAF临床参与者中风（5198对5303），出血事件（5369对5491）和死亡（14,158对14,413）较少。获得的QALYs略有增加（1.67 QALYs/人对1.66 QALYs/人），每人节省74澳元的成本（14,187澳元对14,261澳元），导致显性ICER。在单向和概率敏感性分析中，ICER仍然占主导地位。结论：RAAF诊所有可能预防中风和出血，节省成本，并可能带来投资回报。决策者采用这种护理模式可以确保提供安全、有效和节省成本的护理，从而减少房颤患者的中风、出血和死亡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.