Objective To systematically identify and appraise existing evidence surrounding economic aspects of anticoagulation service interventions for patients with atrial fibrillation. Methods We searched the published and grey literature up to October 2019 to identify relevant economic evidence in any health care setting. A narrative-synthesis approach was taken to summarise evidence by economic design and type of service intervention, with costs expressed in pound sterling and valued at 2017 to 2018 prices. Results A total of 13 studies met our inclusion criteria from 1,168 papers originally identified. Categories of interventions included anticoagulation clinics (n = 4), complex interventions (n = 4), decision support tools (n = 3) and patient-centred approaches (n = 2). Anticoagulation clinics were cost-saving compared with usual care (range for mean cost difference: £188–£691 per-patient per-year) with equivalent health outcomes. Only one economic evaluation of a complex intervention was conducted; case management was more expensive than usual care (mean cost difference: £255 per-patient per-year) and the probability of its cost-effectiveness did not exceed 70%. There was limited economic evidence surrounding decision support tools or patient-centred approaches. Targeting service interventions at high-risk groups and those with suboptimal treatment was most likely to result in cost savings. Conclusion This review revealed some evidence to support the cost-effectiveness of anticoagulation clinics. However, summative conclusions are constrained by a paucity of economic evidence, a lack of direct comparisons between interventions, and study heterogeneity in terms of intervention, comparator and study year. Further research is urgently needed to inform commissioning and service development. Data from this review can inform future economic evaluations of anticoagulation service interventions.

中文翻译：

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系统评价增加心房颤动抗凝药物使用的服务干预措施的经济方面


目的 系统地识别和评估有关房颤患者抗凝服务干预措施的经济方面的现有证据。方法 我们检索了截至 2019 年 10 月的已发表文献和灰色文献，以找出任何医疗保健环境中的相关经济证据。采用叙述综合方法根据经济设计和服务干预类型总结证据，成本以英镑表示，并按 2017 年至 2018 年的价格估值。结果 从最初确定的 1,168 篇论文中，共有 13 项研究符合我们的纳入标准。干预措施的类别包括抗凝诊所 (n = 4)、复杂干预措施 (n = 4)、决策支持工具 (n = 3) 和以患者为中心的方法 (n = 2)。与常规护理相比，抗凝诊所可以节省成本（平均成本差异范围：每位患者每年 188 英镑至 691 英镑），并且具有相同的健康结果。仅对一项复杂的干预措施进行了一次经济评估；病例管理比常规护理更昂贵（平均成本差异：每位患者每年 255 英镑），并且其成本效益的概率不超过 70%。关于决策支持工具或以患者为中心的方法的经济证据有限。针对高风险群体和治疗效果欠佳的群体进行服务干预最有可能节省成本。结论 本综述揭示了一些支持抗凝诊所成本效益的证据。然而，总结性结论受到缺乏经济证据、干预措施之间缺乏直接比较以及干预措施、比较者和研究年份方面的研究异质性的限制。 迫切需要进一步的研究来为调试和服务开发提供信息。该综述的数据可以为未来抗凝服务干预措施的经济评估提供信息。