Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom.
Thromb Haemost. 2022 Mar;122(3):394-405. doi: 10.1055/a-1515-9428. Epub 2021 Jul 11.
To systematically identify and appraise existing evidence surrounding economic aspects of anticoagulation service interventions for patients with atrial fibrillation.
We searched the published and grey literature up to October 2019 to identify relevant economic evidence in any health care setting. A narrative-synthesis approach was taken to summarise evidence by economic design and type of service intervention, with costs expressed in pound sterling and valued at 2017 to 2018 prices.
A total of 13 studies met our inclusion criteria from 1,168 papers originally identified. Categories of interventions included anticoagulation clinics ( = 4), complex interventions ( = 4), decision support tools ( = 3) and patient-centred approaches ( = 2). Anticoagulation clinics were cost-saving compared with usual care (range for mean cost difference: £188-£691 per-patient per-year) with equivalent health outcomes. Only one economic evaluation of a complex intervention was conducted; case management was more expensive than usual care (mean cost difference: £255 per-patient per-year) and the probability of its cost-effectiveness did not exceed 70%. There was limited economic evidence surrounding decision support tools or patient-centred approaches. Targeting service interventions at high-risk groups and those with suboptimal treatment was most likely to result in cost savings.
This review revealed some evidence to support the cost-effectiveness of anticoagulation clinics. However, summative conclusions are constrained by a paucity of economic evidence, a lack of direct comparisons between interventions, and study heterogeneity in terms of intervention, comparator and study year. Further research is urgently needed to inform commissioning and service development. Data from this review can inform future economic evaluations of anticoagulation service interventions.
系统地识别和评估现有关于心房颤动患者抗凝服务干预的经济方面的证据。
我们检索了截至 2019 年 10 月的已发表和灰色文献，以确定任何医疗保健环境中相关的经济证据。采用叙述性综合方法，根据经济设计和服务干预类型总结证据，成本用英镑表示，并按 2017 年至 2018 年的价格进行估值。
从最初确定的 1168 篇论文中，共有 13 项研究符合我们的纳入标准。干预措施类别包括抗凝诊所（ = 4）、复杂干预（ = 4）、决策支持工具（ = 3）和以患者为中心的方法（ = 2）。与常规护理相比，抗凝诊所具有成本效益（平均成本差异范围：每位患者每年 188 至 691 英镑），且具有等效的健康结果。只有一项复杂干预的经济评估，病例管理比常规护理更昂贵（每位患者每年的平均成本差异：255 英镑），其成本效益的概率不超过 70%。决策支持工具或以患者为中心的方法的经济证据有限。针对高风险人群和治疗效果不理想的人群的服务干预最有可能节省成本。
本综述提供了一些证据支持抗凝诊所的成本效益。然而，由于经济证据不足、干预措施之间缺乏直接比较以及干预、对照和研究年份方面的研究异质性，总结性结论受到限制。迫切需要进一步研究为委托和服务开发提供信息。本综述的数据可用于未来抗凝服务干预的经济评估。
