title: Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation.
abstract: OBJECTIVE
  A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiveness of this nurse-led care programme vs. usual care.
  
  
  RESULTS
  A cost-effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline-adherent management, steered by dedicated software, supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per life-year and a cost per quality-adjusted life-year (QALY) analysis was performed, both from a hospital perspective. The nurse-led care programme was associated with slightly more life-years and QALYs at a lower cost. Specifically, the nurse-led programme contributed to 0.009 QALY gains with a reduced cost of €1109 per patient and a gain of 0.02 life-years with a reduced cost of €735 per patient. Therefore, the nurse-led programme would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led programme is considered to be more likely cost-effective than the care as usual.
  
  
  CONCLUSIONS
  The cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach will save costs and improve survival and quality of life, and is therefore a cost-effective management strategy for patients with AF.
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, P.O. box 5800, 6202 AZ Maastricht, The Netherlands. Jeroen.Hendriks@maastrichtuniversity.nl
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendriks
authors.forename: Florian
authors.initials: F
authors.lastname: Tomini
authors.forename: Thea
authors.initials: T
authors.lastname: van Asselt
authors.forename: Harry
authors.initials: H
authors.lastname: Crijns
authors.forename: Hubertus
authors.initials: H
authors.lastname: Vrijhoef
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality* / Q000451:nursing*; D064646:Cardiovascular Nursing / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Adherence to guidelines; Atrial fibrillation; Cardiovascular hospitalization and death; Cost-effectiveness; Nursing; Outpatient care