Key result
Following MAPPP app recommendations dominates periprocedural anticoagulation cost-effectiveness, reducing ICER by ~$430,000.
Why the study?
After validating the effectiveness of the MAPPP app in the post-procedural period, the authors aimed to study its overall cost-effectiveness.
Does following the MAPPP app recommendations improve cost-effectiveness in patients on long-term anticoagulants during the periprocedural period?
Does following the MAPPP app recommendations improve cost-effectiveness in patients on long-term anticoagulants during the periprocedural period?
Absolute Event Rate: 0.7134% vs 0.7104%
p-value: p=not statistically significant
Following the MAPPP app recommendations for periprocedural anticoagulation management is a cost-effective, dominant strategy compared to not following them.
May support MAPPP app use for periprocedural anticoagulation cost savings; leaves open confirmation via randomized trials before practice change.
The Management of Anticoagulation in the Periprocedural Period (MAPPP) app is a free tool providing up-to-date guidelines on the periprocedural management of patients on long-term anticoagulants. After validating its effectiveness in the post-procedural period, we aimed to study its overall cost-effectiveness. SF-12 surveys were sent to eligible patients, converted into SF-6D forms, and subsequently into quality-adjusted life years (QALYs) to calculate the incremental cost-effectiveness ratio (ICER). The number of 30-day readmissions was used to calculate hospitalization costs, utilizing publicly available data. From 1/1/2018 to 1/31/2019, 642 patients were screened for enrollment, with an overall response rate of 94% (164/175) among the consented and 49% (164/336) among all eligible patients. The average QALY score was 0.7134 (95% CI [0.6836, 0.7431]) for the patients whose treatment plan followed the MAPPP app recommendations (acceptance group) and 0.7104 (95% CI [0.6760, 0.7448]) for those who did not (rejection group), without statistically significant differences. The difference in ICER scores was -$429 866.67, with the negative sign demonstrating that acceptance was the dominant strategy. By utilizing QALYs and ICER scores we have shown that the acceptance of MAPPP app recommendations is the dominant strategy for the periprocedural management of patients on long-term anticoagulation.
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Wang et al. (2023) studied Patients on long-term anticoagulants requiring periprocedural management (n=164). Management of Anticoagulation in the Periprocedural Period (MAPPP) app recommendations vs. Rejection of MAPPP app recommendations was evaluated on Quality-adjusted life years (QALYs) (p=not statistically significant). Acceptance of the MAPPP app recommendations was the dominant cost-effectiveness strategy for periprocedural anticoagulation management, with an ICER score difference of -$429,866.67.
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