Why did you (and your colleagues) write this paper? What was its main purpose?

NICHOLAS JONES

Up to a third of eligible patients with atrial fibrillation are currently not prescribed anticoagulation, despite the evidence showing it can reduce stroke risk by over 65%. Funding is being invested into anticoagulation service delivery with the aim of addressing this problem, but the most cost-effective approach remains uncertain. We therefore conducted a systematic review in which we aimed to summarise the economic evidence and compare the cost-effectiveness of anticoagulation service interventions to provide results that could inform future resource allocation decisions. 

What are the main conclusions? 

NICHOLAS JONES

Overall, we found there is a paucity in the scope and volume of existing evidence regarding the cost-effectiveness of anticoagulation service interventions. We did find some limited evidence to suggest that service interventions aimed at groups of patients at high stroke risk were most likely to result in cost savings and that nurse or pharmacist-led anticoagulation clinics could be cost saving compared to usual care.  

What are the paper's implications? - to the public? -to medical professionals?

NICHOLAS JONES

Our results suggest a two-tiered approach to anticoagulation delivery might be necessary. More intensive interventions may be best targeted at a minority of high-risk patients who are not adequately treated. Low cost, light touch interventions, such as shared decision-making software, regular audit and education sessions could be suitable for most patients, possibly supported by nurse or pharmacist-led anticoagulation clinics.  

Are the findings clinically significant? Should the findings change practice?

NICHOLAS JONES

Our review identifies an important research gap. Developing cost-effective approaches to anticoagulation delivery should be seen as a research priority to inform healthcare decision makers who plan care pathways.