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Cost-Effectiveness of Population Screening for Atrial Fibrillation
Quick Takes
- Screening for AF using a portable hand-held ECG monitor is cost-effective in a population of older Swedish adults.
- AF screening resulted in 65 quality-adjusted life-years gained.
- AF screening was associated with an estimated €1.77 million (~$1,761,455 US dollars) lower cost compared to not screening.
Study Questions:
Is screening for atrial fibrillation (AF) among older adults cost-effective?
Methods:
This study aimed to estimate the cost-effectiveness of population-based screening for AF using Markov cohort models. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study; collected via the National Patient Register, the Prescription Register, and the Cause of Death Register. The STROKESTOP study, which randomized 27,975 adults (from two regions in Sweden) aged 75-76 years into a screening invitation group and a control group, had a median follow-up time of 6.9 years. Of the 13,979 participants randomized to the screening group, 7,165 used the hand-held electrocardiography (ECG) recorder. Participants were asked to collect two 30-second recordings per day for 2 weeks. AF was defined as at least one 30-second recording with irregular rhythm and no p-waves or two or more similar episodes lasting 10-29 seconds during a 2-week recording period. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death were taken from the literature.
Results:
Per 1,000 individuals invited to the screening, there were 77 gained life-years, and 65 gained quality-adjusted life-years. The incremental cost was €1.77 million lower in the screening invitation group. Gained quality-adjusted life-years to a lower cost means that the screening strategy was dominant. The result from 10,000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1,000 individuals resulted in 10.6 (95% confidence interval [CI], −22.5 to 1.4) fewer strokes (8.4 ischemic and 2.2 hemorrhagic strokes), 1.0 (95% CI, −1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI, −18.2 to 13.1) fewer bleedings associated with hospitalization.
Conclusions:
The investigators concluded that based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective.
Perspective:
These data suggest that population-based AF screening is cost-effective for older adults. However, it should be noted that the STROKESTOP study was conducted in two regions in Sweden and may not be generalizable to other populations. Thus, understanding the effectiveness and related costs of AF screening in other countries with different insurance structures, and in other populations with different racial/ethnic compositions or AF risk factors, is warranted.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Prevention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Anticoagulants, Atrial Fibrillation, Cost-Benefit Analysis, Electrocardiography, Embolism, Geriatrics, Hemorrhagic Stroke, Ischemic Stroke, Risk Factors, Secondary Prevention, Stroke, Vascular Diseases
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