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Aims <p>Stroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but their clinical outcomes and cost–effectiveness are uncertain. This study aimed to perform a cost–effectiveness evaluation, from a healthcare system perspective, of an RAAF clinic within a large regional health service in Australia.</p> Methods <p>We developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022 and 2023. Clinic data were used to determine risk of stroke, major bleeding and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a 2-year time horizon, with individuals replicated 1000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALYs) and healthcare costs for the RAAF compared with standard of care, which were used to determine incremental cost–effectiveness ratios (ICER), with 5% annual discounting.</p> Results <p>The RAAF clinic participants experienced fewer strokes (5198 versus 5303), bleeding events (5369 versus 5491) and deaths (14,158 versus 14,413). There were marginal increases in QALYs gained (1.67 versus 1.66 QALYs/person), and cost savings of AUD$74 per person (AUD$14,187 versus AUD$14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.</p> Conclusions <p>RAAF clinics are likely to prevent strokes and bleeding, are cost-saving and could lead to returns on investment. Adoption of this model of care by policy-makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding and death in people with atrial fibrillation.</p>

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Rapid Access Atrial Fibrillation Clinics in Australia – Modelling Outcomes and Cost–Effectiveness

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月30日

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  • Adam C. Livori,
  • Ansu Alex,
  • Tamrat Abebe,
  • J. Simon Bell,
  • Zanfina Ademi,
  • Jedidiah I. Morton

摘要

Aims

Stroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but their clinical outcomes and cost–effectiveness are uncertain. This study aimed to perform a cost–effectiveness evaluation, from a healthcare system perspective, of an RAAF clinic within a large regional health service in Australia.

Methods

We developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022 and 2023. Clinic data were used to determine risk of stroke, major bleeding and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a 2-year time horizon, with individuals replicated 1000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALYs) and healthcare costs for the RAAF compared with standard of care, which were used to determine incremental cost–effectiveness ratios (ICER), with 5% annual discounting.

Results

The RAAF clinic participants experienced fewer strokes (5198 versus 5303), bleeding events (5369 versus 5491) and deaths (14,158 versus 14,413). There were marginal increases in QALYs gained (1.67 versus 1.66 QALYs/person), and cost savings of AUD$74 per person (AUD$14,187 versus AUD$14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.

Conclusions

RAAF clinics are likely to prevent strokes and bleeding, are cost-saving and could lead to returns on investment. Adoption of this model of care by policy-makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding and death in people with atrial fibrillation.