Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
J Med Econ. 2021 Jan-Dec;24(1):87-95. doi: 10.1080/13696998.2020.1860371.
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.
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.
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.
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.
从澳大利亚医疗保健系统的角度评估房颤疾病管理计划（即 SAFETY 计划）的长期成本效益。
基于 SAFETY 随机对照试验的患者水平数据，开发了多状态马尔可夫模型。通过外推参数生存模型来估计依赖住院史的长期生存预测。质量调整生命年（QALY）和生命年（LY）是用于估计增量成本效用/效果比（ICUR/ICER）的主要和次要结果测量指标。进行了确定性和概率敏感性分析（PSA）。
与标准护理相比，SAFETY 计划与更高的成本（94953 美元与 78433 美元）和更高的效益[QALY（3.99 与 3.60）；LY（5.86 与 5.24）]相关，ICUR 为 42513 美元/QALY 或 ICER 为 26356 美元/LY。由于延长了生存，SAFETY 与更多的住院治疗（14.85 次与 11.65 次）和更高的药物费用（25084 美元与 22402 美元）和门诊护理费用（12904 美元与 11524 美元）相关。平均住院时间、分析时间范围和药物成本的每住院治疗费用是 ICUR 的关键决定因素。PSA 表明，该干预措施在 50000 美元/QALY 的阈值下具有 70.4%的成本效益可能性。
SAFETY 计划对房颤患者具有很高的成本效益可能性。它存在不确定性，进一步的研究可能会消除这种不确定性；建议在进一步收集证据的基础上实施。
