Key result
One-time AF screening for 75-year-olds proves cost-effective vs no screening at ~$12,500 per QALY.
Why the study?
The long-term outcomes and costs related to population screening for AF to reduce ischemic stroke in the Asian elderly remain unknown.
Does population screening for atrial fibrillation improve cost-effectiveness and prevent ischemic strokes in the elderly?
Does population screening for atrial fibrillation improve cost-effectiveness and prevent ischemic strokes in the elderly?
Effect estimate: ICER $12,493
Both one-time and annual population screening for atrial fibrillation in individuals aged 65 to 80 years appear to be cost-effective in Taiwan.
May support cost-effective AF screening in elderly Taiwanese; leaves open prospective validation and broader generalizability.
Background: Atrial fibrillation (AF) screening identifies undiagnosed patients who can benefit from anticoagulant therapy, thereby reducing the risk of ischemic stroke. However, the long-term outcomes and costs related to population screening for this purpose in the Asian elderly remain unknown. Objectives: This study aimed to evaluate the cost-effectiveness of population screening for AF in the elderly in Taiwan and explore the optimal screening strategy from the health care sector's perspective. Methods: Using a Markov decision-analytic model, we simulated lifetime outcomes and costs of AF screening in a cohort of 10,000 individuals aged 75. Comparative analyses with a nonscreening approach assessed prevented ischemic strokes, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to address model uncertainty, while scenario analyses were performed to determine the optimal age and frequency of screening. Results: One-time population screening for AF among 75-year-olds prevented 45 ischemic strokes and gained 47.42 QALYs, with an additional cost of $592,450 (ICER: $12,493 per QALY gained). The cost-effectiveness of screening remained robust in sensitivity analyses, with anticoagulant effectiveness in ischemic stroke prevention being the most influential factor. Similar ICERs were observed for individuals aged 65 to 80 years. Implementing annual screening for individuals aged 65 to 80 years yielded an ICER of approximately $18,000 per QALY gained. Conclusions: Both one-time and annual population screening for AF in individuals aged 65 to 80 years appear to be cost-effective. Further research is needed to assess budgetary and feasibility aspects to establish an optimal screening program.
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Fu et al. (2024) studied Atrial fibrillation (n=10,000). Population screening for atrial fibrillation vs. Nonscreening approach was evaluated on Incremental cost-effectiveness ratio (ICER) per QALY gained (ICER $12,493). One-time population screening for atrial fibrillation among 75-year-olds was cost-effective compared to no screening, yielding an incremental cost-effectiveness ratio of $12,493 per QALY gained.
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