The business case for quality improvement: oral anticoagulation for atrial fibrillation
Authors
Rose, Adam J.Berlowitz, Dan R.
Ash, Arlene S.
Ozonoff, Al
Hylek, Elaine M.
Goldhaber-Fiebert, Jeremy D.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2011-07-01Keywords
Administration, OralAged
Anticoagulants
Atrial Fibrillation
Costs and Cost Analysis
Follow-Up Studies
Hemorrhage
Humans
Male
Models, Economic
*Quality Improvement
Risk
Stroke
Survival Analysis
Veterans Health
Warfarin
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: The potential to save money within a short time frame provides a more compelling "business case" for quality improvement than merely demonstrating cost-effectiveness. Our objective was to demonstrate the potential for cost savings from improved control in patients anticoagulated for atrial fibrillation. METHODS AND RESULTS: Our population consisted of 67 077 Veterans Health Administration patients anticoagulated for atrial fibrillation between October 1, 2006, and September 30, 2008. We simulated the number of adverse events and their associated costs and utilities, both before and after various degrees of improvement in percent time in therapeutic range (TTR). The simulation had a 2-year time horizon, and costs were calculated from the perspective of the payer. In the base-case analysis, improving TTR by 5% prevented 1114 adverse events, including 662 deaths; it gained 863 quality-adjusted life-years and saved $15.9 million compared with the status quo, not accounting for the cost of the quality improvement program. Improving TTR by 10% prevented 2087 events, gained 1606 quality-adjusted life-years, and saved $29.7 million. In sensitivity analyses, costs were most sensitive to the estimated risk of stroke and the expected stroke reduction from improved TTR. Utilities were most sensitive to the estimated risk of death and the expected mortality benefit from improved TTR. CONCLUSIONS: A quality improvement program to improve anticoagulation control probably would be cost-saving for the payer, even if it were only modestly effective in improving control and even without considering the value of improved health. This study demonstrates how to make a business case for a quality improvement initiative.Source
Circ Cardiovasc Qual Outcomes. 2011 Jul;4(4):416-24. Epub 2011 Jun 28. Link to article on publisher's siteDOI
10.1161/CIRCOUTCOMES.111.960591Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46538PubMed ID
21712521Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1161/CIRCOUTCOMES.111.960591