Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review

Abstract

Background Atrial fibrillation (AF) remains the most common form of cardiac arrhythmia. Management of AF aims to reduce the risk of stroke, heart failure and premature mortality via rate or rhythm control. This study aimed to review the literature on the cost effectiveness of treatment strategies to manage AF among adults living in low-, middle- and high-income countries. Methods We searched MEDLINE (OvidSp), Embase, Web of Science, Cochrane Library, EconLit and Google Scholar for relevant studies between September 2022 and November 2022. The search strategy involved medical subject headings or related text words. Data management and selection was performed using EndNote library. The titles and abstracts were screened followed by eligibility assessment of full texts. Selection, assessment of the risk of bias within the studies, and data extraction were conducted by two independent reviewers. The cost-effectiveness results were synthesised narratively. The analysis was performed using Microsoft Excel 365. The incremental cost effectiveness ratio for each study was adjusted to 2021 USD values. Results Fifty studies were included in the analysis after selection and risk of bias assessment. In high-income countries, apixaban was predominantly cost effective for stroke prevention in patients at low and moderate risk of stroke, while left atrial appendage closure (LAAC) was cost effective in patients at high risk of stroke. Propranolol was the cost-effective choice for rate control, while catheter ablation and the convergent procedure were cost-effective strategies in patients with paroxysmal and persistent AF, respectively. Among the anti-arrhythmic drugs, sotalol was the cost-effective strategy for rhythm control. In middle-income countries, apixaban was the cost-effective choice for stroke prevention in patients at low and moderate risk of stroke while high-dose edoxaban was cost effective in patients at high risk of stroke. Radiofrequency catheter ablation was the cost-effective option in rhythm control. No data were available for low-income countries. Conclusion This systematic review has shown that there are several cost-effective strategies to manage AF in different resource settings. However, the decision to use any strategy should be guided by objective clinical and economic evidence supported by sound clinical judgement. Registration CRD42022360590. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-023-01276-5.

Fibrinaloid Microclots and Atrial Fibrillation

“…Atrial fibrillation (AF) is at once the commonest heart arrhythmia (Chugh et al 2014;Corica et al 2023a;Zulkifly et al 2018) and a chief cause of death therefrom (Benjamin et al 1998;Staerk et al 2017). Its global incidence amounts to millions of individuals (Chugh et al 2014), possibly 1% of populations, and even 20 years ago its cost represented some 1% of the NHS budget, with all these numbers on a rising trend (Camacho and Lip 2023;Dai et al 2021;Okafor et al 2023;Sun et al 2023), albeit with large regional differences of incidence and/or reporting (e.g. South Asia is said to be 12x lower than North America (Joseph et al 2021)).…”

Fibrinaloid Microclots and Atrial Fibrillation

“…Atrial fibrillation (AF) is at once the commonest heart arrhythmia [1][2][3] and a chief cause of death therefrom [4,5]. Its global incidence amounts to millions of individuals [1], possibly 1% of populations, and even 20 years ago, its cost represented some 1% of the NHS budget, with all these numbers on a rising trend [6][7][8][9], albeit with large regional differences of incidence and/or reporting (e.g., South Asia is said to be 12× lower than North America [10]).…”