Aims Stroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but clinical outcomes and cost-effectiveness of them are uncertain. This study aimed to perform a cost-effectiveness evaluation of a RAAF clinic within a large regional health service in Australia.

Methods We developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022-2023. Clinic data was used to determine risk of stroke, major bleeding, and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a two-year time horizon, with individuals replicated 1,000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALY) and healthcare costs for the RAAF compared to standard of care, which were used to determine incremental cost-effectiveness ratios (ICER), with 5% annual discounting

Results The RAAF clinic participants experienced fewer strokes (5,198 vs 5,303), bleeding events (5,369 vs 5,491) and deaths (14,158 vs 14,413). There were marginal increases in QALYs gained (1.67 vs. 1.66 QALY/person), and cost savings of $74 per person ($14,187 vs $14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.

Conclusion RAAF clinics are likely to prevent strokes, bleeding, and are cost-saving and could lead to returns on investment. Adoption of this model of care by policy makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding, and death in people with atrial fibrillation.

AL Consulting for Sanofi, Boehringer Ingelheim, Novartis JSB is supported by a National Health and Medical Research Council (NHMRC) Boosting Dementia Research Leadership Fellowship and has received grant funding or consulting funds from the NHMRC, Medical Research Future Fund, Victorian Government Department of Health, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations unrelated to this work. All grants and consulting funds were paid to the employing institution. AA, TA, ZA, JIM No conflicts to declare relevant to this publication

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JIM was supported by a Heart Foundation Postdoctoral Fellowship (ID: 108269-2024) from the National Heart Foundation of Australia.

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Ethics approval was obtained from the Grampians Health Ballarat Human Research Ethics Committee (Project number107482 LNR//BHSSJOG) and Monash University Human Research Ethics Committee (43967).

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The individual-level data underlying this article cannot be shared publicly due to privacy reasons. However, the protocol containing all code used to generate this study is available at: https://github.com/cardiopharmnerd/raafcea.