Resource use and cost associated with computerized decision support system and usual care in managing patients with atrial fibrillation: analysis of IMPACT-AF randomized trial data

• Published in: BMC medical informatics and decision making 2023-10, Vol.23 (1), p.1-228, Article 228
• Main Authors: Humphries, Brittany, Cox, Jafna L, Parkash, Ratika, Thabane, Lehana, Foster, Gary A, MacKillop, James, Nemis-White, Joanna, Hamilton, Laura, Ciaccia, Antonio, Choudhri, Shurjeel H, Kovic, Bruno, Xie, Feng
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Atrial fibrillation; Cardiac arrhythmia; Caregivers; Clinical practice guidelines; Cost analysis; Costs; Data collection; Decision support systems; Decision support tool; Diaries; Dyspnea; Edema; Embolisms; Emergency medical care; Emergency medical services; Fibrillation; Health care expenditures; Health care policy; Heart failure; Hospitalization; Impact analysis; Ischemia; Medical records; Patients; Primary care; Questionnaires; Randomized controlled trial; Resource utilization; Sociodemographics; Statistical analysis; Stroke; Transient ischemic attack
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-023-02329-7

BackgroundIMPACT-AF is a prospective, randomized, cluster design trial comparing atrial fibrillation (AF) management with a computerized decision support system (CDS) to usual care (control) in the primary care setting of Nova Scotia, Canada. The objective of this analysis was to compare the resource use and costs between CDS and usual care groups.MethodsCase costing data, 12-month self-administered questionnaires, and monthly diaries from IMPACT-AF were used in this analysis. Descriptive statistics were used to compare costs and resource use between groups. All costs are presented in 2021 Canadian dollars and cover the 12-month period of participation in the study.ResultsA total of 1,145 patients enrolled in the trial. Case costing data were available for 466 participants (41.1%), 12-month self-administered questionnaire data for 635 participants (56.0%) and monthly diary data for 223 participants (19.7%). Emergency department visits and hospitalizations comprised the most expensive component of AF care. Across all three datasets, there were no statistically significant differences in costs or resource use between CDS and usual care groups.ConclusionsAlthough there were no significant differences in resource use or costs among CDS and usual care groups in the IMPACT-AF trial, this study provides insight into the methodology and practical challenges of collecting economic data alongside a trial.RegistrationClinicaltrials.gov (registration number: NCT01927367, date of registration: 2013-08-20).