Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis

Abstract

Background Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. Conclusions This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation.

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: a post-hoc analysis from the prospective GLORIA-AF Registry

“… 10 , 11 , 12 These beneficial findings on clinical outcomes were prospectively tested in the mAFA-II cluster randomised trial 13 and further supported by a recent systematic review and meta-analysis 14 and cost-effectiveness analysis. 15 Given such strong evidence, recent international AF guidelines 16 , 17 have recommended the implementation of such an integrated care approach for the management of AF, based on the ABC pathway.…”

Measuring Mobile Phone Application Usability for Anticoagulation from the Perspective of Patients, Caregivers, and Healthcare Professionals

“…Despite the context and features, formative evaluations should be conducted to test design assumptions. Although the mHealth apps have the potential to save money through the improvement of treatment adherence and behavior changes, the cost-effectiveness of mHealth app remains unclear [ 35 , 36 ]. Despite the resource intensity in the development stage, the study team also realized a need for timely mobile technology support for the SmartMed app end-users after implementation to facilitate ongoing accessible and effective OAC care.…”

Atrial fibrillation: epidemiology, screening and digital health

“… 58 In a hypothetical cohort within the mAFA-II trial, the base-case analysis indicated cost-effectiveness of applying mHealth-based integrated care for AF with cost-effective ratio of US $14,936 per quality-adjusted life years, which was below the willingness-to-pay (US $33,438 per quality-adjusted life years). 59 However, these findings should be interpreted cautiously due to the model-based approach, short follow-up, region-specific factors, and multiple cost inputs (including expert opinions).…”

“… 58 China RCT 2062 (men) 1262 (women) 68 ± 14 70 ± 13 0% 100% ≥12 months Death/ischemic stroke/systemic thromboembolism/rehospitalization (IC vs UC): HR 0.30, 95% CI 0.17–0.52 (men), HR 0.50, 95% CI 0.27–0.92 (women) Thromboembolism: NS Death: HR 0.32, 95% CI 0.12–0.87 (men) Rehospitalization: HR 0.29, 95% CI 0.15–0.57 (men), HR 0.31, 95% CI 0.14–0.68 (women) Bleeding): NS RAF/HF/MI: HR 0.32, 95% CI 0.18–0.56 (men) Luo et al. 59 China Cost benefit analysis NA NA NA 30 y Costs (IC vs UC): US $35,691 vs US $34,601 QALY gain: 7.2749 vs 7.2019 ICER below WTP: US $14,936 vs US $33,438 per QALY Guo et al. 55 China RCT 360 (IC) 354 (UC) 73 ± 13 73 ± 14 45% 35% 12 months Death/ischemic stroke/systemic thromboembolism, rehospitalization (IC vs UC): HR 0.40, 95% CI 0.21–0.76 (no HF) RAF/HF/MI: HR 0.26, 95% CI 0.14–0.48 (no HF) HR 1.99, 95% CI 1.08–3.69 (HF) Gawalko et al.…”

“…A total of 33 publications were considered relevant. Of those, 14 publications reported on integrated e-health enhanced management of AF, 47 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 5 on remote AF management platforms, 65 , 66 , 67 , 68 , 69 3 publications on mHealth-based heart rate/rhythm monitoring, 70 , 71 , 72 6 publications on mHealth supported patient self-care and medication adherence tools 73 , 74 , 75 , 76 , 77 , 78 and 5 publications reported on clinical decision making support tools. 79 , 80 , 81 , 82 , 83 …”