scholarly journals Implications of Achieving TICI 2b Versus TICI 3 Reperfusion in Patients With Ischemic Stroke: A Cost-Effectiveness Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Xiao Wu ◽  
Dheeraj Gandhi ◽  
Charles C Matouk ◽  
Joseph Schindler ◽  
Danny Hughes ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Old Patients ◽  
Life Years ◽  
Outcome Differences

Abstract INTRODUCTION The degree of successful reperfusion of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) is one of the critical and potentially modifiable determinants of clinical outcome. Differences in outcomes between patients with TICI 2b vs TICI 3 reperfusion have recently been highlighted. This study examines the public health and cost implications of achieving TICI 2b vs TICI 3 reperfusion. METHODS A decision-analytic study was performed to estimate the lifetime quality-adjusted life years (QALY) and associated costs based on the degree of reperfusion achieved. The base case calculations and multiple one-way sensitivity analyses were performed for AIS patients with LVO undergoing MT in 3 age groups: 55, 65, and 75 yr old, respectively. RESULTS Within 90 d, achieving TICI 3 results in a cost-saving of $5,258 per patient and health benefit of 7.3 d in perfect health as compared to TICI 2b. In the long-term, for the 3 ages groups (55, 65, and 75 yr old), achieving TICI 3 results in cost savings of $82,965, $51,155, and $31,034 respectively, and health benefits of 2.42 QALYs, 1.92 QALYs, and 1.36 QALYs. Every 1% increase in TICI 3 in 55-yr-old patients at a nation-wide level results in a cost saving of nearly $6.1 million and a health benefit of 176 QALYs. Among 65-yr-old patients, the corresponding cost savings and health benefit are $3.7 million and 176 QALYs, and $2.3 million and 99 QALYS for 75-yr-old patients. CONCLUSION There are substantial cost and health implications of achieving complete vs incomplete reperfusion after EVT. Our study reinforces the need for a more conservative definition of therapy success and treatment approaches to achieve TICI 3 reperfusion.

Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis

2020 ◽  
pp. neurintsurg-2020-015873 ◽  
Author(s):  
Xiao Wu ◽  
Mihir Khunte ◽  
Dheeraj Gandhi ◽  
Charles Matouk ◽  
Danny R Hughes ◽  
...  
Keyword(s):  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
The United States ◽  
Base Case ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Old Patients ◽  
Life Years

BackgroundThe benefit of endovascular thrombectomy (EVT) in stroke patients with large-vessel occlusion (LVO) depends on the degree of recanalization achieved. We aimed to determine the health outcomes and cost implications of achieving TICI 2b vs TICI 3 reperfusion in acute stroke patients with LVO.MethodsA decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years (QALY) of EVT-treated patients, and costs based on the degree of reperfusion achieved. The study was performed with a societal perspective in the United States' setting. The base case calculations were performed in three age groups: 55-, 65-, and 75-year-old patients.ResultsWithin 90 days, achieving TICI 3 resulted in a cost saving of $3676 per patient and health benefit of 11 days in perfect health as compared with TICI 2b. In the long term, for the three age groups, achieving TICI 3 resulted in cost savings of $46,498, $25,832, and $15 719 respectively, and health benefits of 2.14 QALYs, 1.71 QALYs, and 1.23 QALYs. Every 1% increase in TICI 3 in 55-year-old patients nationwide resulted in a cost saving of $3.4 million and a health benefit of 156 QALYs. Among 65-year-old patients, the corresponding cost savings and health benefit were $1.9 million and 125 QALYs.ConclusionThere are substantial cost and health implications in achieving complete vs incomplete reperfusion after EVT. Our study provides a framework to assess the cost-benefit analysis of emerging diagnostic and therapeutic techniques that might improve patient selection, and increase the chances of achieving complete reperfusion.

scholarly journals Hepatitis C in Lebanon: burden of the disease and value of comprehensive screening and treatment

2018 ◽  
Vol 12 (02.1) ◽  
pp. 27S
Author(s):  
Antoine Abou Rached ◽  
Selim Abou Kheir ◽  
Jowana Saba ◽  
Salwa Assaf ◽  
Georges Kassis ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
Decompensated Cirrhosis ◽  
Mortality Data ◽  
Health State ◽  
Life Years ◽  
Number Of Patients ◽  
Lebanese Population

Introduction: As few reliable data on the burden of hepatitis C virus (HCV) are available from the Middle East, we analyzed HCV burden in the Lebanese population and the value of comprehensive screening and treatment at different age groups and fibrosis stages. Methodology: A multi-cohort, health-state-transition model was developed to project the number of HCV patients achieving a sustained virologic response 12 weeks after treatment (SVR12) or progressing to compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), and liver-related death (LrD) from 2016 to 2036. Epidemiology and mortality data were extracted from the Ministry of Health bulletin while costs were collected from insurance claims. The proportion of patients screened for HCV was projected to increase to 60%/85%/99% (low/medium/high screening scenarios) in 2036, with a new cohort being diagnosed each year. SVR12 rates were extracted from clinical trials. Separate models were used for 18-39 and 40- 80 age groups to account for different prevalence and screening rates. Results: Low, medium and high HCV screening scenarios showed that 3,838, 5,665 and 7,669 individuals would be diagnosed with HCV infection from 2016 to 2036, 40% aged 18-39 and 60% aged 40-80. In the absence of treatment, the projected number of patients reaching CC, DCC, HCC and LrD in 2036 was 899, 147, 131 and 147 respectively for the 18-39 age groups. In the 40-80 age groups, these projections were substantially greater: 2,828 CC, 736 DCC, 668 HCC and 958 LrD. The overall economic burden of these complications would reach 150 million €. However, introducing direct-acting antivirals (DAAs) for F0-F4 patients would increase by 43% and 62% the proportion of remaining life-years (LYs) spent in SVR12 compared to DAAs given to F2-F4 or to F3-F4 only, respectively. Although DAAs for F0-F4 increase the cost of HCV treatment, they also provide the greatest health benefit and lowest cost per LY gained in SVR12. Compared to no treatment and screening, adopting the high screening variant and DAAs access to F0-F4 would cost an additional 1,957 € for every LY gained in SVR12 for patients aged 18-39 and -168 € for the 40-80 age group. Conclusion: An enhanced screening policy coupled with broader access to DAAs will diminish the future burden of HCV in the Lebanese population and provide the greatest health benefits among middle-aged and elder adults with net cost savings.

scholarly journals Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Sheena Xin Liu ◽  
Rui Xiang ◽  
Charles Lagor ◽  
Nan Liu ◽  
Kathleen Sullivan
Keyword(s):  
Heart Failure ◽  
Cost Saving ◽  
Hospital Admissions ◽  
Clinical Performance ◽  
Cost Savings ◽  
Time Frame ◽  
Economic Modeling ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Year Gain

Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from$2832 to$5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in$2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

scholarly journals Cost-effectiveness of TLC-NOSF dressings versus neutral dressings for the treatment of diabetic foot ulcers in France

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245652
Author(s):  
Franck Maunoury ◽  
Anaïs Oury ◽  
Sophie Fortin ◽  
Laetitia Thomassin ◽  
Serge Bohbot ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diabetic Foot ◽  
Cost Savings ◽  
Wound Dressings ◽  
Sensitivity Analyses ◽  
Foot Ulcers ◽  
Base Case ◽  
Diabetic Foot Ulcers ◽  
Lifetime Horizon ◽  
Life Years

This study assesses the cost-effectiveness of Technology Lipido-Colloid with Nano Oligo Saccharide Factor (TLC-NOSF) wound dressings versus neutral dressings in the management of diabetic foot ulcers (DFUs) from a French collective perspective. We used a Markov microsimulation cohort model to simulate the DFU monthly progression over the lifetime horizon. Our study employed a mixed method design with model inputs including data from interventional and observational studies, French databases and expert opinion. The demographic characteristics of the simulated population and clinical efficacy were based on the EXPLORER double-blind randomized controlled trial. Health-related quality of life, costs, and resource use inputs were taken from the literature relevant to the French context. The main outcomes included life-years without DFU (LYsw/DFU), quality-adjusted life-years (QALYs), amputations, and lifetime costs. To assess the robustness of the results, sensitivity and subgroup analyses based on the wound duration at treatment initiation were performed. Treatment with the TLC-NOSF dressing led to total cost savings per patient of EUR 35,489, associated with gains of 0.50 LYw/DFU and 0.16 QALY. TLC-NOSF dressings were established as the dominant strategy in the base case and all sensitivity analyses. Furthermore, the model revealed that, for every 100 patients treated with TLC-NOSF dressings, two amputations could be avoided. According to the subgroup analysis results, the sooner the TLC-NOSF treatment was initiated, the better were the outcomes, with the highest benefits for ulcers with a duration of two months or less (+0.65 LYw/DFU, +0.23 QALY, and cost savings of EUR 55,710). The results from the French perspective are consistent with the ones from the German and British perspectives. TLC-NOSF dressings are cost-saving compared to neutral dressings, leading to an increase in patients’ health benefits and a decrease in the associated treatment costs. These results can thus be used to guide healthcare decisionmakers. The potential savings could represent EUR 3,345 per treated patient per year and even reach EUR 4,771 when TLC-NOSF dressings are used as first line treatment. The EXPLORER trial is registered with ClinicalTrials.gov, number NCT01717183.

scholarly journals Cost-effectiveness of an indicated preventive intervention for depression in adolescents

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Ssegonja ◽  
F Sampaio ◽  
I Alaie ◽  
A Philipson ◽  
L Hagberg ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Preventive Intervention ◽  
Health Benefits ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Preventive Interventions ◽  
Subsyndromal Depression ◽  
Life Years

Abstract Background Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. Methods A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. Results The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented more cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. Limitations: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. Conclusions GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated. Key messages Indicated preventive interventions for depression are cost-saving and can generate substantial health benefits. Indicated preventive interventions can be adopted as cost-effective preventive strategies for depression.

Economic evaluation of six and 12 month (m) treatment with isatuximab and carfilzomib and dexamethasone (IKd) versus daratumumab and carfilzomib and dexamethasone (DKd) in patients with relapsed or refractory multiple myeloma (RRMM).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20010-e20010
Author(s):  
Neda AlRawashdh ◽  
Briana Choi ◽  
Mavis Obeng-Kusi ◽  
Matthias Calamia ◽  
Ali McBride ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Transition Probabilities ◽  
Cost Savings ◽  
Medication Administration ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Treatment Comparison ◽  
Life Years

e20010 Background: Isatuximab and daratumumab target the CD38 transmembrane glycoprotein on MM cells. IKd and DKd regimens have shown reductions of HR=0.53 (95%CI 0.32-0.89) and HR=0.63 (95%CI 0.46-0.85) resp. in progression or death risk compared to Kd in RRMM. In the absence of a direct IKd vs DKd trial, we performed an indirect treatment comparison on progression free survival (PFS) to enable cost-effectiveness analyses. Methods: A 3-state (pre-progression, progression, death) partitioned survival model was specified. NMA-adjusted transition probabilities were estimated from fitted exponential functions (time horizon of 6 and 12 m; cycle length 28 days). Inputs included the Wholesale Acquisition Cost of IKd, DKd, and premedications; cost of medication administration; and cost of adverse event management. Utility inputs for pre-progression (0.65) and progression (0.61) were per literature. Costs and utilities were discounted at 3.5%/y. A payer perspective was adopted. Life years (LY), quality adjusted LY (QALY), and incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) were estimated in base case (BCA) and probabilistic sensitivity analyses (PSA). Cost-effectiveness acceptability curves (CEAC) were generated. Results: As detailed in the Table, 6m of IKd treatment was associated with incremental gains of 0.01 (PSA 0.01) LYs but no gains in QALYs at cost savings of $24,188 ($23,762), yielding a dominant ICER of $ -2,418,800 ($-2,376,200) per LYg (ICUR not estimable). Further, 12m of IKd treatment was associated with incremental gains of 0.04 (PSA 0.04) LYs (or 0.48m) and 0.02 (0.03) QALYs at incremental cost of $1,585 ($2,239), yielding ICER of $39,625 ($55,975) per LYg and ICUR of $79,250 ($74,633) per QALYg. Per CEAC, IKd is the dominated strategy in the 6m model and had probability of 50% of being cost-effective at WTP of $100,000 in the 12m model. Conclusions: Clinically, compared to DKd, IKd is associated with slight incremental gains in LYs of 0.12m over 6m and 0.48m over 1y. The 6m clinical gain comes with cost savings of approximately $24,000 or about 15% of IKd therapy, while the 12m gain requires a minimal cost commitment of around $2,000 or 0.6% of DKd treatment. These findings imply a clinico-economic benefit of isatuximab compared to daratumumab containing regimens in RRMM. [Table: see text]

EXPRESS: Drip-and-Ship versus Mothership for Endovascular Treatment of Acute Stroke: A Comparative Effectiveness Analysis

2021 ◽  
pp. 174749302110087
Author(s):  
Xiao Wu ◽  
Charles Wira ◽  
Charles Matouk ◽  
Howard Forman ◽  
Dheeraj Gandhi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Health Benefit ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Model Parameters ◽  
Stroke Patients ◽  
Case Scenario ◽  
Life Years ◽  
Stroke Center

Background Triage for suspected acute stroke has two main options (1) transport to the closest primary stroke center (PSC) and then to the nearest comprehensive stroke center (CSC) (Drip-and-Ship) or (2) transport the patient to the nearest CSC, bypassing a closer PSC (mothership). The purpose was to evaluate the effectiveness of drip-and-ship versus mothership models for acute stroke patients. Methods A Markov decision-analytic model was constructed. All model parameters were derived from recent medical literature. Our target population is adult patient with sudden onset of acute stroke over a one-year horizon. The primary outcome is quantified in term of quality-adjusted-life-years (QALYs). Results The base-case scenario shows the Drip-and-Ship strategy has a slightly higher expected health benefit, 0.591 QALY, as compared to 0.586 QALY in the Mothership strategy when the time to PSC is 30 minutes and to CSC is 65 minutes, although the difference in health benefit becomes minimal as the time to PSC increases towards 60 min. Multiple sensitivity analyses show that when both PSC and CSC are far from place of onset (>1.5 hours away), Drip-and-Ship becomes the better strategy. Mothership strategy is favored by smaller difference between distances to PSC and CSC, shorter transfer time from PSC to CSC, and longer delay in reperfusion in CSC for transferred patients. Drip-and-Ship is favored by the reverse. Conclusion Drip-and-ship has a slightly higher utility than mothership. This study assesses the complex issue of prehospital triage of acute stroke patients, and can provide a framework for real-world data input.

Abstract MP019: Should Global Cardiovascular Risk Guide Treatment of Stage One Hypertension? A Cost-effectiveness Analysis

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Andrew Moran ◽  
Petra Rasmussen ◽  
Rachel Zhao ◽  
Pamela G Coxson ◽  
David Guzman ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Risk Function ◽  
Annual Number ◽  
Base Case ◽  
Cvd Risk ◽  
Policy Model ◽  
Life Years ◽  
Stage 1

Introduction: Current U.S. hypertension guidelines base treatment on clinic blood pressure (BP) alone. International guidelines recommend adding global cardiovascular disease (CVD) risk to guide treatment. We projected incremental effectiveness and costs of treating stage 1 hypertension based on CVD risk assessment. Methods: We used the Coronary Heart Disease (CHD) Policy Model, a validated state-transition simulation of the CVD epidemic in the US, to model CHD and stroke events, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness (ICE) of increasingly aggressive treatment of hypertensive patients. Census and national survey data were used to estimate joint distributions of risk factors by age and sex; the CVD risk function was based on Framingham. We modeled treatment of BP to an approximate target <140/90 mmHg using standard dose medications, including averaged annual drug costs (e.g., $253 for a systolic BP reduction of 11.5 mmHg; $1,036 for reduction of 36.7 mmHg) and monitoring costs (2 or 4 visits/year for stage 1 or 2 plus 1 lab test/year for all). We compared a strategy in which only stage 2 hypertensives (≥160/≥100 mmHg) were treated to increasingly aggressive strategies in which stage 1 hypertensives (140-159/90-99 mmHg) with successively lower global CVD risk (15%, 10%, 5% risk, then all of stage 1) were also treated. Results: Reaching hypertension treatment targets with any policy simulated would prevent between 389,000 and 478,000 CVD events annually ( Table ). Treating all stage 2 and ≥15% CVD risk stage 1 hypertensives would be cost-saving and treating stage 1 with ≥10% or ≥5% CVD risk would incur modest costs. Treating all stage 1 would cost $161,000/QALY more than treating only ≥5% CVD risk. Conclusions: Treatment of low risk stage 1 hypertensives appears to come at high cost and limited added benefit unless treatment costs can be minimized. Using global CVD risk assessment might allow re-allocation of resources toward controlling hypertension in the highest risk patients. Table Simulated CVD outcomes, costs, and cost-effectiveness, 2010-2011, the CHD Policy Model Scenario Annual number hypertensives treated Annual CVD events Annual QALYs (millions) Annual costs (millions, $US) ICER * Base case, no intervention - 2,387,000 127.67 $827,313 reference Treat only stage 2 23,364,180 1,997,000 128.78 $825,264 cost saving Treat stage 2 + stage 1 >=15% CVD risk 30,654,361 1,943,000 128.93 $824,541 cost saving Treat stage 2 + stage 1 >=10% CVD risk 34,947,200 1,928,000 128.97 $824,898 $9,381 Treat stage 2 + stage 1 >= 5% CVD risk 44,321,985 1,913,000 129.02 $826,433 $28,931 Treat stage 2 + all stage 1 50,863,390 1,909,000 129.04 $828,290 $160,630 *ICER = difference in cost/difference in QALY in comparison with the next less effective strategy

scholarly journals Cost-effectiveness of Triple Therapy with Telaprevir for Chronic Hepatitis C Virus Patients in Germany

10.36469/9870 ◽  
2013 ◽  
Vol 1 (3) ◽  
pp. 239-253 ◽  
Author(s):  
Jona T. Stahmeyer ◽  
Svenja Schauer ◽  
Siegbert Rossol ◽  
Hans Heinrich Wedemeyer ◽  
Daniel Wirth ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis C ◽  
Triple Therapy ◽  
Sensitivity Analyses ◽  
Healthcare Sector ◽  
Base Case ◽  
Life Years ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
The Cost

Background: About 400,000-500,000 people are infected with hepatitis C in Germany. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of first generation protease inhibitors has significantly improved the treatment of hepatitis C genotype 1 patients. The aim of the study was to assess the cost-effectiveness of triple therapy with telaprevir in Germany. Methods: We used a Markov model on disease progression and natural history to assess the cost-effectiveness of triple therapy with telaprevir compared to standard treatment with pegylated interferon and ribavirin. Model structure and inputs were discussed with clinical experts. Deterministic and probabilistic sensitivity analyses were performed to verify the robustness of results. Results: The base-case analyses shows that triple therapy results in higher costs (untreated patients: €48,446 vs. €30,691; previously treated patients: €63,228 vs. €48,603) and better outcomes (untreated patients: 16.85 qualily of life years [QALYs] vs. 15.97 QALYs; previously treated patients: 14.16 QALYs vs. 12.89 QALYs). The incremental cost-effectiveness ratio (ICER) was €20,131 per QALY and €30,567 per life year gained (LYG) for previously untreated patients. ICER in treatment experienced patients was €7,664 per QALY for relapse patients, €12,506 per QALY for partial responders and €28,429 per QALY for null responders. Results were robust in sensitivity analyses. Conclusion: Although triple therapy with telaprevir leads to additional costs, there is a high probability of being cost-effective for different thresholds. This health economic analysis makes an important contribution to current debates on cost savings and efficient resource allocation in the German healthcare sector.

Cost-effectiveness of mobile health-based integrated care for atrial fibrillation: Model development and data analysis (Preprint)

2021 ◽  
Author(s):  
Xueyan Luo ◽  
Wei Xu ◽  
Quan Yuan ◽  
Han Lai ◽  
Chunji Huang
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Integrated Care ◽  
Mobile Health ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Years ◽  
Mhealth Technology

BACKGROUND Mobile health (mhealth) technology is increasingly used in disease management. Using mhealth tools to integrate and streamline care was found to improve atrial fibrillation (AF) patients’ clinical outcomes. OBJECTIVE This study aimed to investigate the potential clinical and health economic outcomes of mhealth-based integrated care for AF from the perspective of a public healthcare provider in China. METHODS A Markov model was designed to compare outcomes of mhealth-based care and usual care in a hypothetical cohort of AF patients in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS In the base-case analysis, mhealth-based care gained higher QALYs of 0.0818 with an incurred cost of USD1,778. Using USD33,438 per QALY (three times gross domestic product) as the willingness-to-pay threshold, mhealth-based care was cost-effective, with an ICER of USD21,739 per QALY. The one-way sensitivity analysis found compliance to mhealth-based care had the greatest impact on the ICER. In probabilistic sensitivity analysis, mhealth-based care was accepted as cost-effective in 80.91% of 10,000 iterations. CONCLUSIONS This study suggested that the use of mhealth technology in streamlining and integrating care for AF patients was cost-effective in China.

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