Resource Use and Costs Associated With Computerized Decision Support System for Managing Patients With Atrial Fibrillation

Speaker(s)

Humphries B1, Cox J2, Parkash R2, Thabane L3, Foster G3, MacKillop J4, Nemis-White J5, Hamilton L6, Ciaccia A7, Choudhri S8, Kovic B3, Xie F3
1McMaster University, Kanata, ON, Canada, 2Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada, 3McMaster University, Hamilton, ON, Canada, 4Sydney Primary Care Medical Clinic, Sydney, NS, Canada, 5Strive Health Management Consulting Ltd, Halifax, NS, Canada, 6QEII Health Sciences Centre, Halifax, NS, Canada, 7Medical Affairs – Cardiovascular Medicine, Bayer Inc, Mississauga, ON, Canada, 8Medical & Scientific Affairs, Bayer Inc, Mississauga, ON, Canada

Presentation Documents

OBJECTIVES: The Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) study was a prospective, randomized, unblinded, cluster designed trial comparing atrial fibrillation (AF) management with a computerized decision support system (CDS) to usual care in the primary care setting of Nova Scotia, Canada. The objective of this analysis was to compare resource use and costs between CDS and usual care groups.

METHODS: Case costing data provided by the Nova Scotia Health Authority, 12-month self-administered questionnaires, and monthly patient diaries informed this analysis. The case costing data comprised of direct public payer costs for AF-related hospitalizations and emergency room visits. The questionnaire and diaries collected additional detail on healthcare resource use and patient costs. Descriptive statistics compared costs and resource use between groups over the 12-month study period.

RESULTS: Among the 1,145 patients enrolled, the mean age was 72.3 years and 61.9% were male. Case costing data were available for 466 participants (41.1%); 12-month self-administered questionnaire data for 635 participants (56.0%); and monthly diary data for 223 participants (19.7%). Across all three datasets, there were no statistically significant differences in costs or resource use between CDS and usual care groups (mean total per-patient direct costs: $1,433 CDS, $1,307 usual care, p=0.8). Emergency department visits and hospitalizations comprised the most expensive component of AF care, while INR testing was the most frequently used resource (mean INR visits: 6.3 CDS, 6.9 usual care). Sensitivity analyses found statistically significant differences in resource use and costs between participants living in urban and rural areas (e.g., distance traveled for GP visits, number of specialist visits).

CONCLUSIONS: Although there were no significant differences in resource use or costs among CDS and usual care groups in the IMPACT-AF trial, this study provides unique insight into the economic burden of AF among patients treated in the primary care setting.

REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01927367

Code

EE528

Topic

Economic Evaluation, Study Approaches

Topic Subcategory

Trial-Based Economic Evaluation

Disease

No Additional Disease & Conditions/Specialized Treatment Areas