Economic evaluation of telemedicine-based integrated management of atrial fibrillation in rural China: a modeling analysis

Fig. 1. Deterministic one-way sensitivity analysis. We performed one-way sensitivity analyses for Telemedicine-based management versus usual care. The top 10 parameters with the greatest impact on ICURs are shown in above figure. Red indicates the lower parameter sensitivity input and blue indicates the higher parameter sensitivity input in Supplementary Table 3. Costs were expressed in 2024 US dollars ($1 = 7.1975 Chinese yuan). IS ischemic stroke, AF atrial fibrillation, ICUR incremental cost utility ratio, QALY quality-adjusted life-year.

Fig. 2. Cost-effectiveness plane and acceptability curve simulating all parameters. A Gray point in the cost-effectiveness plane represents one of 10,000 simulations of incremental cost and QALY pairs, varying all parameters in Supplementary Table 3. The red point indicates the base-case estimate. B The red acceptability curve shows the proportion of simulations deemed cost-effective across varying willingness-to-pay thresholds, indicating that telemedicine-based integrated management is cost-effective. The dashed and dot-dashed purple lines denote one-time and three-times rural China’s per-capita GDP in 2024 ($11,906 and $35,718), respectively. Costs were expressed in 2024 US dollars ($1 = 7.1975 Chinese yuan). QALY quality-adjusted life-year, GDP gross domestic product, ICUR incremental cost-utility ratio.

Fig. 3. Cost-effectiveness plane and acceptability curve simulating strategy-related parameters (Scenario 1). A Gray point in the cost-effectiveness plane represents one of 10,000 simulations of incremental cost and QALY pairs, varying strategy-related parameters in Supplementary Table 3. The red point indicates the base-case estimate. B The red acceptability curve shows the proportion of simulations deemed cost-effective across varying willingness-to-pay thresholds, indicating that telemedicine-based integrated management is cost-effective. The dashed and dot-dashed purple lines denote one-time and three-times rural China’s per-capita GDP in 2024 ($11,906 and $35,718), respectively. Costs were expressed in 2024 US dollars ($1 = 7.1975 Chinese yuan). QALY quality-adjusted life-year, GDP gross domestic product, ICUR incremental cost-utility ratio.

Fig. 4. Markov model showing possible transitions between health states. Patients start out with uncomplicated AF, then cycle between health states until death occurs or the 15-year period ends. The length of each cycle is 30 days. The health states are equivalent for two management strategies, but the probabilities, costs, and quality of life vary with strategy. Any health state could lead to death (not shown). AF Atrial fibrillation, HF heart failure, ECH extracranial hemorrhage, ACS acute coronary syndrome, IS ischemic stroke.