Developing a simulation tool to support decisions around the commissioning of anticoagulation services for patients with atrial fibrillation

Atrial fibrillation (AF), an arrhythmia characterized by chaotic electrical activity in the atria, is a public health problem affecting countries experiencing aging population ageing. AF not only increases the risk of stoke five-fold but a stroke suffered by this group of patients are more significant and result in more serious harm and greater mortality. Historically, Warfarin and aspirin have been the treatments of choice but recent guidance states that aspirin should not be used as a monotherapy. More recently a new class of drugs was developed, Novel Oral Anti-Coagulants (NOACs), which aim to treat AF while avoiding some of the drawbacks of Warfarin. However, each treatment comes with costs and benefits for both the patient and care system which need to be taken into account when planning the organisation of stroke prevention services at a regional or national level. Our aim was to develop a prototype modelling software tool to help with decisions around the organisation of anti-coagulation and stroke prevention services at regional level. Specifically, we constructed a stochastic simulation model representing patients with AF on different treatments and their respective outcomes. We implemented a prototype software tool to allow the execution of computer simulation experiments. Finally, we experimented with a number of showcasing scenarios that evaluate the likely impact of changes of in the mixture of medication treatments on patient and system level outcomes.