Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording

Aronsson, Mattias; Svennberg, Emma; Rosenqvist, Mårten; Engdahl, Johan; Al‐Khalili, Faris; Friberg, Leif; Frykman-Kull, V.; Levin, Lars‐Åke

doi:10.1093/europace/euv083

Cited by 137 publications

(146 citation statements)

References 40 publications

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“…Przesiewowe wykrywanie niemego klinicznie AF poprzez wykonywanie EKG podczas rutynowych wzyt lekarskich www.kardiologiapolska.pl wydaje się efektywne kosztowo w populacjach w wieku starszym (np. > 65 lat) [131], a podobne wyniki uzyskiwano, wykonując przesiewowo jednoodprowadzeniowe EKG w innych grupach ryzyka [132,133]. Przesiewowa ocena w starszej populacji (średni wiek 64 lata) wykazała częstość występowania przewlekłych postaci AF wynoszącą 2,3% wśród 122 571 uczestników, u których rejestrowano krótki zapis EKG lub badano palpacyjnie tętno (a następnie rejestrowano EKG u osób z niemiarowym tętnem) [134].…”

Section: Przesiewowe Wykrywanie Niemegounclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,399

4,206

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Section: Przesiewowe Wykrywanie Niemegounclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,399

4,206

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“…This identified 261 records, of which eight papers [99][100][101][102][103][104][105][106] not previously identified were considered relevant after title and abstract screening and a further four papers [107][108][109][110] were highlighted as providing information on costs.…”

Section: Outcomes Of the Economic Evaluationmentioning

confidence: 99%

“…[116][117][118] In total, after title and abstract screening we identified 27 studies for which full-text articles were obtained and screened. After screening the full texts, nine studies 19,21,25,96,99,100,116,117 of economic evaluations of population-based screening strategies were identified. In the following section, we summarise the nine economic evaluations of population-based screening for AF, which are also described in Table 18.…”

Section: -115mentioning

confidence: 99%

“…For the repeated screening strategies, we conducted a sensitivity analysis assuming an annual rate of diagnosis in the absence of screening or an AF-related stoke of 5%, as assumed by Aronsson et al, 100 compared with 1% based on the control arm of the SAFE study 19 used in the base case. As one would expect, the INB decreases as the diagnosis rate in the absence of screening or AF-related stroke increases (Table 49).…”

Section: Diagnosis In the Absence Of Screening Or An Atrial Fibrillatmentioning

confidence: 99%

“…The study by Aronsson et al 100 was a cost-effectiveness analysis of systematic population screening for AF in 75-and 76-year-olds in Sweden using intermittent ECG recording based on data from the ongoing STROKESTOP study. 40 Future consequences were tracked over a patient's lifetime using a Markov model, depending on CHA 2 DS 2 -VASc score and treatment.…”

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confidence: 99%

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Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

122

116

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices

et al. 2022

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Key Points Question Is population-based atrial fibrillation (AF) screening using wearable devices cost-effective? Findings In this economic evaluation of 30 million simulated individuals with an age, sex, and comorbidity profile matching the US population aged 65 years or older, AF screening using wearable devices was cost-effective, with the overall preferred strategy identified as wearable photoplethysmography, followed conditionally by wearable electrocardiography with patch monitor confirmation (incremental cost-effectiveness ratio, $57 894 per quality-adjusted life-year). The cost-effectiveness of screening was consistent across multiple scenarios, including strata of sex, screening at earlier ages, and with variation in the association of anticoagulation with risk of stroke associated with screening-detected AF. Meaning This study suggests that contemporary AF screening using wearable devices may be cost-effective.

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Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording

Abstract: With the use of a decision analytic simulation model, it has been shown that screening for asymptomatic AF in 75/76-year-old individuals is cost-effective.

Cited by 137 publications

References 40 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices

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