4 March 2024

Research with integrated health economics

Significance for society as a whole

Most clinical intervention and observational studies aim to develop or improve treatment options. They are designed to directly benefit patients. Their impact on the social system and public health is an interesting but under-researched aspect. Health economics deals with precisely such questions. It aims to provide evidence for the efficient and sustainable design and development of healthcare. As healthcare systems differ greatly between countries, a national perspective is of crucial importance.

Health economic research integrated into clinical studies and cohorts

It can be very useful to consider health economic issues directly in the context of clinical trials or cohorts. This approach is called "within trial analysis" or "within clinical study analysis". Such projects have already been successfully carried out several times, for example in the Swiss Atrial Fibrillation Cohort(Swiss-AF) under the direction of Prof. Matthias Schwenkglenks. Swiss-AF is a prospective observational study funded by the University Heart Center Basel (PI Prof. Michael Kühne) and the Swiss National Science Foundation (SNSF), which is being conducted at a total of 13 centers throughout Switzerland and is investigating the relationship between atrial fibrillation and impaired brain function. A large amount of data is being collected as part of Swiss-AF, which is extremely valuable for answering health economic questions, for example in combination with insurance data.

The relevance of health economic aspects

Around 100,000 people in Switzerland suffer from atrial fibrillation. Taking into account the secondary diseases, the economic impact of this cardiac arrhythmia can be estimated to be considerable. In the coming years, a significant increase in prevalence and further effects on the healthcare system can be expected. The collection of health economic data within Swiss-AF was therefore taken into account from the outset. In addition to the documentation of hospital stays and outpatient visits, questionnaires are also used to record productivity losses such as incapacity to work or reduced workloads. Participants' billing data is also available from collaborations with health insurers.

Costs of atrial fibrillation and cost-benefit considerations of treatment options

The following publications from Swiss-AF are examples of health economic research projects based on clinical studies or cohorts that can provide important information for decision-makers in the healthcare system.

Aebersold et al. (2023a) have precisely quantified the costs caused by atrial fibrillation for the Swiss healthcare system. They show that the direct medical costs of patients with atrial fibrillation are around 50 percent higher over a five-year period compared to the population without known atrial fibrillation. In total, the costs associated with atrial fibrillation were extrapolated to 700 million Swiss francs, which corresponds to around one percent of total healthcare expenditure in Switzerland. Indirect costs such as the impact on the labor market are not included in this analysis.

Aebersold et al. (2023b) also identified three patient groups (cardiovascular dominated, isolated symptomatic, severely morbid without caridiovascular disease) for which the resulting costs and quality of life are clearly different. These data are helpful both for cost estimates in clinical practice and for the planning of future clinical trials.

Serra-Burriel et al, 2022 report on the cost-benefit analysis of an electrosurgical minimally invasive method for the treatment of atrial fibrillation, known as pulmonary vein isolation (PVI). They show that this intervention is superior to drug therapy in the long term, i.e. over a period of ten years, at CHF 80,000 per quality-adjusted life year (QALY) gained from a health economic perspective.

Consideration as early as the study planning stage

Collaboration between clinical research groups, the Health Economics Facility (HEF) and the DKF is to be further expanded in the future. When planning clinical intervention or observational studies, it should always be considered whether additional data on the cost-effectiveness of treatment options can be collected. Funding institutions such as the SNF are also increasingly recognizing the importance of integrating health economic surveys.