Economic evaluation of telemedicine-based integrated management of atrial fibrillation in rural China: a modeling analysis

Abstract Atrial fibrillation (AF) imposes a substantial disease and economic burden worldwide, particularly in rural areas with limited access to integrated care. The MIRACLE-AF trial demonstrated significant reductions in cardiovascular mortality, stroke, and heart failure or acute coronary syndrome hospitalizations with telemedicine-based, village doctor-led integrated management versus usual care. We conducted an economic evaluation of this management among patients aged ≥65 years in rural China. A Markov model was developed from the healthcare provider perspective to simulate a hypothetical cohort over a 15-year horizon. Outcomes included incremental cost-effectiveness ratios (ICERs) per cardiovascular death avoided and per stroke avoided, and incremental cost-utility ratios (ICURs) per quality-adjusted life-year (QALY) gained. Costs were expressed in 2024 US dollars ($1 = 7.1975 CNY), with a willingness-to-pay threshold of $35,718 (three times rural China’s per-capita GDP in 2024). Compared with usual care, telemedicine-based integrated yielded ICERs of $60,692 per cardiovascular mortality and $4,880 per stroke avoided, and a favorable ICUR of $4,554 per QALY gained. Probabilistic sensitivity analysis indicated cost-effective in 97.60% of simulations, with results most sensitive to the number of patients managed per village doctor. These findings support telemedicine-based, village doctor-led integrated AF management as a potential cost-effective strategy in resource-limited rural settings.