Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study
Key result
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.
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Why the study?
Previous studies on the cost-effectiveness of screening for AF were based on assumptions of long-term clinical effects rather than observed clinical outcomes.
Is population-based screening for atrial fibrillation cost-effective in elderly persons aged 75/76 years?
Key Points
- This study aims to estimate the cost-effectiveness of population screening for atrial fibrillation using clinical outcomes over a median follow-up of 6.9 years.
- Study involving 27,975 individuals aged 75/76 years assigned to screening or control groups.
- Utilized a Markov cohort model to analyze clinical outcomes and costs.
- Performed probabilistic sensitivity analysis based on literature data and study findings.
- Per 1000 individuals screened, 77 life years and 65 quality-adjusted life years gained.
- Screening resulted in a €1.77 million lower incremental cost.
- In 10,000 simulations, the screening strategy was cost-effective in 99.2% of cases and cost-saving in 92.7%.
Study Design
Type
RCT (n=27,975)
Structured PICO
Is population-based screening for atrial fibrillation cost-effective in elderly persons aged 75/76 years?
P
Population
27,975 persons aged 75/76 years from the STROKESTOP study
I
Intervention
Population-based screening invitation for atrial fibrillation
C
Comparator
Control group (no screening invitation)
O
Outcome
Cost-effectiveness (incremental cost, gained life years, and gained quality-adjusted life years)
Population-based screening for atrial fibrillation in elderly individuals is a dominant, cost-saving strategy that improves quality-adjusted life years.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The greatest benefit from screening is that you receive information that could be used to reduce an individual's risk of stroke and thus may help them live longer with a good quality of life.”
“The results mean that decision-makers will be in a better position about deciding whether to move forward with recommending screening for atrial fibrillation in Sweden as well as internationally. In future studies, we need to examine what it looks like in other health care settings in other countries and in different ethnical groups, and also if other age groups could benefit from screening.”
“Now, that may sound like a small difference, but you must bear in mind that only about half of those invited to screening participated and it's possible we would have seen a more pronounced difference had more people turned up for screening. Those who participated in the screening had significantly fewer negative events.”
Implication
Should not yet change screening practice; leaves open whether modeled stroke reductions justify costs in unselected populations.
Abstract
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.
Discussion
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Cite This Study
Lyth et al. (2022) conducted an 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.