Key result
Opportunistic AF screening in geriatric outpatients ≥75 years is the most cost-effective single-screen strategy.
Why the study?
Cost-effectiveness analyses of different atrial fibrillation screening programmes are difficult to compare due to varying settings and models used.
Does single-time point screening for atrial fibrillation improve quality-adjusted life-years and reduce costs in adults ≥65 or ≥75 years?
Does single-time point screening for atrial fibrillation improve quality-adjusted life-years and reduce costs in adults ≥65 or ≥75 years?
Single-time point screening strategies for atrial fibrillation, particularly opportunistic screening in high-risk groups like geriatric outpatients, are highly cost-saving.
Opportunistic geriatric AF screening may be cost-saving; supports consensus but leaves prospective validation open.
AIMS: Screening for atrial fibrillation (AF) is recommended by the European Society of Cardiology guidelines to prevent strokes. Cost-effectiveness analyses of different screening programmes for AF are difficult to compare because of varying settings and models used. We compared the impact and cost-effectiveness of various AF screening programmes in the Netherlands. METHODS AND RESULTS: The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the ARISTOTLE, RE-LY, and ROCKET AF trials combined with Dutch observational data. Univariate, probabilistic sensitivity, and various scenario analyses were performed. The maximum number of newly detected AF patients in the Netherlands ranged from 4554 to 39 270, depending on the screening strategy used. Adequate treatment with anticoagulation would result in a maximum of >3000 strokes prevented using single-time point AF screening. Compared with no screening, screening 100 000 people provided a gain in QALYs ranging from 984 to 8727 and a mean cost difference ranging from -6650 000€ to 898 000€, depending on the screening strategy used. The probabilistic sensitivity analysis (PSA) demonstrated a 100% likelihood that screening all patients ≥75 years visiting the geriatric outpatient clinic was cost-saving. Four out of six strategies were cost-saving in ≥74% of the PSA simulations. Out of these, opportunistic screening of all patients ≥65 years visiting the GPs office had the highest impact on strokes prevented. CONCLUSION: Most single-time point AF screening strategies are cost-saving and have an important impact on stroke prevention.
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Hulst et al. (2022) studied Atrial Fibrillation. Opportunistic and systematic single-time point atrial fibrillation screening strategies vs. No screening was evaluated on Gain in quality-adjusted life-years (QALYs) and mean cost difference per 100,000 screened people compared to no screening. Most single-time point atrial fibrillation screening strategies were cost-saving, with opportunistic screening of patients ≥75 years visiting a geriatric outpatient clinic being the dominant and most cost-effective strategy.
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