Cost-effectiveness of a score-guided educational intervention to improve anticoagulation control in anticoagulant naïve Thai patients with atrial fibrillation (TREATS-AF)

Background Atrial fibrillation imposes substantial costs with Thai patients often relying on warfarin with suboptimal control. Objective To establish cost-effectiveness for the Thai health system of a SAMe-TT 2 R 2 score-guided treatment strategy with educational intervention to improve patients' anticoagulation control with warfarin. Methods A trial-based economic evaluation compared the score-guided treatment strategy with educational intervention against usual care in Thai Primary Care and Pharmacies. A trial-based cost-utility analysis estimated the cost-per-additional QALY of the strategy, whilst a cost-effectiveness analysis established cost-per-percentage point increase in time in therapeutic range (TTR) Results The intervention had higher costs and lower QALYs than usual care, with an incremental cost of Thai baht (THB) 3,359 and incremental QALY difference of −0.03. Consistent with this finding, the bootstrapped analysis showed the intervention had a low probability of being cost-effective: 4% at a willingness-to-pay threshold of THB 160,000 per QALY. Results were robust to sensitivity analyses. Despite lower quality of life outcomes, the cost-effectiveness analysis suggested a small uncertain improvement in TTR with 62% of bootstrapped replications favouring the intervention and mean increase of 0.92 percentage points, for an additional cost of around THB 3500. Higher costs were driven mainly by intervention costs. Conclusion It is highly likely a SAMe-TT 2 R 2 score-guided strategy with educational intervention alongside usual care (TREATS-AF) is not cost-effective in terms of cost-per-additional QALY or improved anticoagulation control (TTR), in anticoagulant-naïve Thai patients with AF, when compared with usual care alone. This suggests that this type of intervention may require further local adaptation and context-specific evaluation.