Cost-Effectiveness of Extended and One-Time Screening Versus No Screening for Non-Valvular Atrial Fibrillation in the USA

Abstract

Background There is limited evidence on the clinical and cost benefits of screening for atrial fibrillation (AF) with electrocardiogram (ECG) in asymptomatic adults. Methods We adapted a previously published Markov model to evaluate the clinical and economic impact of one-time screening for non-valvular AF (NVAF) with a single 12-lead ECG and a 14-day extended screening with a hand-held ECG device (Zenicor single-lead ECG, Z14) compared with no screening. Clinical events considered included ischemic stroke, systemic embolism, major bleeds, myocardial infarction, and death. Epidemiology and effectiveness data for extended screening were from the STROKESTOP study. Risks of clinical events in NVAF patients were derived from ARISTOTLE. Analyses were conducted from the perspective of a third-party payer, considering a population with undiagnosed NVAF, aged 75 years in the USA. Costs and utilities were discounted at a 3% annual rate. Parameter uncertainty was formally considered via deterministic and probabilistic sensitivity analyses (DSA and PSA). Structural uncertainty was assessed via scenario analyses. Results In a hypothetical cohort of 10,000 patients followed over their lifetimes, the number of additional AF diagnoses was 54 with 12-lead ECG and 255 with Z14 compared with no screening. Both screening strategies led to better health outcomes (ischemic strokes avoided: ECG 12-lead, 9.8 and Z14, 42.2; quality-adjusted life-years gained: ECG 12-lead, 31 and Z14, 131). Extended screening and one-time screening were cost effective compared with no screening at a willingness-to-pay

Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model

“…Other studies have suggested both clinical and cost‐effectiveness of AF screening using traditional modalities such as pulse palpation, 12‐lead ECG, and patch monitoring. 32 , 34 In our analysis, we found that pulse palpation followed conditionally by 12‐lead ECG resulted in similar QALY estimates as no screening, and screening using 12‐lead ECG alone generally resulted in reduced QALYs. Given the multitude of possible AF screening approaches and the generally low stroke rates among individuals with detected AF, conducting well‐powered randomized trials comparing each strategy is infeasible.…”

Cost-Effectiveness Of Atrial Fibrillation Screening Strategies: A Systematic Review

“…ICER in this study reported $ 58,728 in the 12-lead ECG mode and $ 47,949 in the Z14. The study also reported that screening the general population at age 75 for NVAF was cost-effective on the threshold of willingness to pay of $ 100,000 [42].…”

“…In this study, the nal cost and ICER with 12-lead ECG were equal to $ 188484860 and 6129.59, respectively. Furthermore, the nal cost and ICER with Z14 were equal to $ 65.4848194 and 77.49967, respectively [42].…”

“…[21,22,28,31,33,36,39,43] Furthermore, three studies used two pulse palpation methods and one type of ECG as a screening test method [37,38,41]. One article also used ECG screening versus no screening [42]. In addition, an article used a method to prevent heart palpitations [30].…”

Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices

“… 54 Given our focus on wearable devices, we did not directly evaluate handheld 1L ECG, although we observed that a similar combination of pulse palpation followed by 12L ECG was on the cost-effectiveness frontier with comparable ICERs. More recently, Oguz et al 55 found that 1-time screening using 12L ECG alone followed by 14-day screening with patch monitor at 75 years of age was also cost-effective. In general, our findings support previous observations suggesting that AF screening can be cost-effective, and they provide new evidence that strategies using wearable devices may be economically favorable.…”