OBJECTIVES: Atrial Fibrillation (AF) is a common and treatable risk factor for ischaemic stroke and vascular dementia with rising incidence. Oral anticoagulation (OAC) therapy is a well-evidenced way to prevent AF-related strokes, as supported by NICE Clinical Guidelines (CG180, 2014).

METHODS: In March 2017 the Academic Health Science Network (AHSN) launched the AF Business Case Model using publicly-reported practice-level data to help Clinical Commissioning Group (CCGs) across England identify specific areas for improving four key gaps in the diagnosis and management of AF. The cost-impact analysis identified the most cost efficient way to increase OAC therapy in order to reduce the risk of stroke, and generates a ‘business case report’ to facilitate local decision-making.

RESULTS: The business case analysis for three regions in England reveals the net cost impact of a 12-month programme to close gaps in AF management. The 3-year net savings, based on combined health and social care costs, were as follows: Yorkshire and the Humber AHSN (101,788 patients on AF register): Identifying undiagnosed AF: £21,469,047; Assessing AF stroke risk: £8,191,236; Initiating OAC in eligible patients: £25,008,659; and Perfecting OAC: £27,134,561. Imperial College Health Partners, North West London (patients on AF register: 23,551): Identifying undiagnosed AF: £9,326,444; Assessing AF stroke risk: £2,393,238; Initiating OAC in eligible patients: £7,176,131; and Perfecting OAC: £5,967,191. Greater Manchester AHSN (patients on AF register: 49, 617): Identifying undiagnosed AF: £10,716,832; Assessing AF stroke risk: £3,655,502; Initiating OAC in eligible patients: £10,997,216; and Perfecting OAC: £12,813,309.

CONCLUSIONS: The AF Care Pathway Business Case Model helps define local healthcare investment priorities along the AF management pathway to achieve long-term cost savings and improvements in clinical outcomes. Initiating and perfecting inadequate OAC in currently diagnosed, eligible patients would achieve the greatest combined cost saving in all three regions reviewed in this cost-impact analysis.