Within trial cost-utility analysis of disease management program for patients hospitalized with atrial fibrillation: results from the SAFETY trial

Figures & data

Table 1. Details of resource utilization and cost components.

	Safety intervention (n = 168)	Standard management (n = 167)
Cost of rehospitalization	$18,282	$21,594
Number of all rehospitalizations	676	735
Number of patients being hospitalized	141	150
Cost of medical services	$8,717	$8,557
Number of primary care physician visits^a	39	38
Number of specialist visits^b	9	11
Number of ECGs^c	5	5
Number of prothrombin tests^d	29	26
Cost of pharmaceuticals	$4,498	$4,402
Number of total scripts dispensed	140	129
Cardiac therapy	12	12
Antihypertensives^e	1	1
Diuretic	4	4
Beta-blocking agents	9	8
Calcium channel blocker	6	5
ARB/ACEI	16	13
Lipid lowering agents	15	14
All the other medications	77	71

^a MBS item number of primary care physician consultations: A1, A10, A11, A14, A15, A17, A18, A22, A2, A20, A23, A7, A21.

^b MBS item number for specialist A3, A4, A5, A8, A28, A26, A24.

^c MBS item for ECG is D1.

^d MBS item for prothrombin test is P1; costs are expressed as means.

^e Not including diuretic, beta-blocking agents, calcium channel blocker, ARB/ACEI. Types may include methyldopa, imidazoline receptor agonist, alpha-adrenoreceptor antagonist, hydrazinophthalazine derivatives, pyrimidine derivatives, and medications to act on pulmonary arterial hypertension.

Abbreviations. ECG, electrocardiograph; ARB/ACEI, angiotensin II receptor blocker/angiotensin converting enzyme inhibitors.

Table 2. Intervention costs.

Item	$/Unit	SM (n = 167)		INT (n = 168)
		Qty	Cost	Qty	Cost
Clinic contacts		235		236
Time (h)	$42.64	235	$23,932	236	$24,034
Home contacts		0	0	519
Visit time (h)	$42.64			597	$60,746
Travel (km)	$0.76			11,849	$9,005
Travel time (h)	$42.64			197	$20,111
Phone contacts		268		1,684
Time (h)	$42.64	11	$1,130	99	$10,131
Total cost			$25,062		$124,027
Per patient (SD)			$150 (86)		$738 (382)

Abbreviations. h, hours; km, kilometres; qty, quantity; SD, standard deviation; SM, standard management group; INT, SAFETY Intervention group.

Table 3. Incremental costs, QALYs, cost-effectiveness ratio.

Analysis	Costs			QALYs			ICUR	INMB (95% CI)
	SM (n = 136)	INT (n = 141)	Difference (95% CI)	SM (n = 136)	INT (n = 141)	Difference (95% CI)
Overall	$48,095	$43,720	−$4,375 (−$19,585: 10,835)	1.20	1.22	0.02 (−0.10: 0.13)	Dominant^a	$9,036 (−$7,551: $25,623)
Sex
Male	$49,678	$43,253	−$6,425 (−$28,042: $15,191)	1.18	1.25	0.07 (−0.10: 0.23)	Dominant^a	$9,851 (−$12,873: $32,485)
Female	$45,785	$43,380	−$2,405 (−$23,580: $18,769)	1.19	1.17	−0.01 (−0.18: 0.16)	nc^b	$8,513 (−$12,974: $30,000)
Age
≤66	$37,915	$31,293	−$6,622 (−$26,163: $12,919)	1.17	1.27	0.11 (−0.10: 0.32)	Dominant^a	$17,252 (−$14,815: $49,319)
67–77	$56,929	$35,064	−$21,865 (−$48,172: $4,442)	1.22	1.30	0.08 (−0.12: 0.28)	Dominant^a	$22,972 (−$2,471: $48,414)
≥78	$47,692	$64,403	$16,711 (−$14,717: $48,138)	1.15	1.07	−0.09 (−0.29: 0.11)	Dominated^c	−$12,170 (−$37,389: $13,047)

^a Positive incremental QALY and cost saving.

^b Not calculated, negative incremental QALY and cost saving.

^c Negative incremental QALY and increased cost.

Abbreviations. CI, confidence interval; ICUR, Incremental Cost Utility Ratio; INMB, Incremental Net Monetary Benefit; INT, SAFETY Intervention group; QALY, Quality Adjusted Life Year; SM, standard management group.

Figure 1. Incremental cost-effectiveness plane.

Table 4. Deterministic sensitivity analyses.

Analysis	Costs			QALYs			ICER
	SM (n = 136)	INT (n = 141)	Difference (95% CI)	SM (n = 136)	INT (n = 141)	Difference (95% CI)
Base case	$48,095	$43,720	−$4,375 (−$19,585: 10,835)	1.20	1.22	0.02 (−0.10: 0.13)	Dominant^a
Discounting
0%	$48,054	$43,698	−$4,355 (−$19,569: $10,857)	1.23	1.25	0.02 (−0.10: 0.14)	Dominant^a
Hospital costs
DRG	$29,121	$27,654	−$1,467 (−$8,437: $3,556)	1.20	1.22	0.02 (−0.10: 0.13)	Dominant^a

^a Positive incremental QALY and cost saving.

Abbreviations. CI, confidence interval; DRG, diagnosis related group; ICER, incremental cost-effectiveness ratio; INT, SAFETY Intervention group; SM, standard management group.

Data availability statement

The data set associated with the paper may be requested from the corresponding author depending on the nature of the request.