Population-based screening for atrial fibrillation was a dominant strategy, gaining 65 quality-adjusted life years and lowering costs by €1.77 million per 1000 individuals invited.
RCT (n=27,975)
Is population-based screening for atrial fibrillation cost-effective in elderly persons aged 75/76 years?
Population-based screening for atrial fibrillation in elderly individuals is a dominant, cost-saving strategy that improves quality-adjusted life years.
AIMS: Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. METHODS AND RESULTS: The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 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 1000 individuals resulted in 10.6 95% confidence interval (CI): -22.5 to 1.4 fewer strokes (8.4 ischaemic and 2.2 haemorrhagic 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. CONCLUSION: Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation.
“Our health economic analysis shows that screening is an intervention that even saves money. What I mean is – screening not only saves lives by preventing stroke; it also saves money for the healthcare system.”
Lyth et al. (Wed,) conducted a rct in Atrial fibrillation (n=27,975). Population-based screening invitation for atrial fibrillation vs. Control group (no screening invitation) was evaluated on Cost-effectiveness (incremental cost and quality-adjusted life years). Population-based screening for atrial fibrillation was a dominant strategy, gaining 65 quality-adjusted life years and lowering costs by €1.77 million per 1000 individuals invited.