Jean-Eric Tarride1, Lisa Dolovich1, Gordon Blackhouse1, Jason Robert Guertin1, Natasha Burke1, Veena Manja1, Alex Grinvalds1, Ting Lim1, Jeff S Healey1, Roopinder K Sandhu1. 1. Affiliations: Departments of Health Research Methods, Evidence, and Impact (Tarride, Blackhouse, Burke, Dolovich) and Family Medicine (Dolovich), and Population Health Research Institute (Grinvalds, Lim, Healey), McMaster University; Programs for Assessment of Technology in Health (Tarride, Blackhouse, Burke, Dolovich), Research Institute of St. Joe's Hamilton, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Guertin), Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec - Université Laval, Axe Santé des populations et pratiques optimales en santé (Guertin), Hôpital du Saint-Sacrement, Québec, Que.; Department of Internal Medicine (Manja), State University of New York at Buffalo; VA Western New York Healthcare System at Buffalo (Manja), Buffalo, NY; Division of Cardiology (Sandhu), University of Alberta, Edmonton, Alta.
Abstract
BACKGROUND: Screening for undiagnosed atrial fibrillation may lead to treatment with oral anticoagulation therapy, which can decrease the risk of ischemic stroke. The objective of this study was to conduct an economic evaluation of the Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy), which screened 1145 participants aged 65 years or more at 30 community pharmacies in Ontario and Alberta between October 2014 and April 2015. METHODS: We used a 2-part decision model to evaluate the short- and long-term costs and quality-adjusted life-years (QALYs) of a pharmacy screening program for atrial fibrillation compared to no screening. Data from the PIAAF-Pharmacy study were used for the short-term model, and the relevant literature was used to extrapolate the benefits of the PIAAF-Pharmacy study in the long-term model. Costs and QALYs were calculated from a payer perspective over a lifetime horizon and were discounted at 1.5%/year. RESULTS: Screening for atrial fibrillation in pharmacies was associated with higher costs ($26) and more QALYs (0.0035) compared to no screening, yielding an incremental cost per QALY gained of $7480. Univariate and probabilistic sensitivity analyses confirmed that screening for atrial fibrillation in a pharmacy setting was a cost-effective strategy. INTERPRETATION: Our results support screening for atrial fibrillation in Canadian pharmacies. Given this finding, efforts should be made by provincial governments and pharmacies to implement such programs in Canada. The addition of atrial fibrillation screening alongside screening and management of other cardiovascular conditions may help to reduce the burden of stroke. Copyright 2017, Joule Inc. or its licensors.
BACKGROUND: Screening for undiagnosed atrial fibrillation may lead to treatment with oral anticoagulation therapy, which can decrease the risk of ischemic stroke. The objective of this study was to conduct an economic evaluation of the Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy), which screened 1145 participants aged 65 years or more at 30 community pharmacies in Ontario and Alberta between October 2014 and April 2015. METHODS: We used a 2-part decision model to evaluate the short- and long-term costs and quality-adjusted life-years (QALYs) of a pharmacy screening program for atrial fibrillation compared to no screening. Data from the PIAAF-Pharmacy study were used for the short-term model, and the relevant literature was used to extrapolate the benefits of the PIAAF-Pharmacy study in the long-term model. Costs and QALYs were calculated from a payer perspective over a lifetime horizon and were discounted at 1.5%/year. RESULTS: Screening for atrial fibrillation in pharmacies was associated with higher costs ($26) and more QALYs (0.0035) compared to no screening, yielding an incremental cost per QALY gained of $7480. Univariate and probabilistic sensitivity analyses confirmed that screening for atrial fibrillation in a pharmacy setting was a cost-effective strategy. INTERPRETATION: Our results support screening for atrial fibrillation in Canadian pharmacies. Given this finding, efforts should be made by provincial governments and pharmacies to implement such programs in Canada. The addition of atrial fibrillation screening alongside screening and management of other cardiovascular conditions may help to reduce the burden of stroke. Copyright 2017, Joule Inc. or its licensors.
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