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

• Published in: Journal of medical Internet research Vol. 24; no. 4; p. e29408
• Main Authors: Luo, Xueyan, Xu, Wei, Ming, Wai-Kit, Jiang, Xinchan, Yuan, Quan, Lai, Han, Huang, Chunji, Zhong, Xiaoni
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 19.04.2022; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications
• Subjects: Analysis; Anticoagulants; Atrial fibrillation; Atrial Fibrillation - therapy; Blood pressure; Cardiac arrhythmia; Clinical outcomes; Clinical research; Clinical trials; Comorbidity; Cost analysis; Cost-Benefit Analysis; Data Analysis; Delivery of Health Care, Integrated; Diabetes; Disease management; Economics; GDP; Gross Domestic Product; Health care industry; Health services; Health status; Heart failure; Humans; Hypertension; Integrated approach; Integrated care; Integrated delivery systems; Markov chains; Markov processes; Medical care, Cost of; Medical personnel; Medical technology; Original Paper; Patients; Population; Public health; Quality adjusted life years; Robustness; Sensitivity analysis; Stroke; Surveys; Symptom management; Telemedicine; Thromboembolism; Willingness to pay; China; United States > US; cost-effectiveness; atrial fibrillation; integrated care; mobile health; model-based; health economic evaluation; ABC pathway
• DOI: 10.2196/29408
• ISSN: 1438-8871; 1439-4456

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). 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. 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. 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. 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.