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Published on: February 26, 2013
Cost-effectiveness of a community-based screening programme for chronic atrial fibrillation in Japan
1Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. maeken@kuhp.kyoto-u.ac.jp
Insights
Community screening for atrial fibrillation (AF) using ECG or pulse palpation is cost-effective in Japan. Both methods prevent ischaemic stroke and are favorable within standard cost-effectiveness criteria.
Area of Science:
- Health Economics
- Cardiology
- Preventive Medicine
Background:
- Atrial fibrillation (AF) is a significant risk factor for ischaemic stroke.
- Early detection and treatment of AF can mitigate stroke risk.
- Cost-effectiveness of screening programs is crucial for healthcare resource allocation.
Purpose of the Study:
- To evaluate the cost-effectiveness of community-based screening for chronic atrial fibrillation (AF) in Japan.
- To compare annual ECG screening and annual pulse palpation screening against no screening.
- To assess the economic impact of AF screening on preventing ischaemic stroke.
Main Methods:
- A Markov process computer model simulated a hypothetical Japanese population aged 65-85.
- Compared annual ECG screening, annual pulse palpation screening, and no screening.
- Modeled outcomes including quality-adjusted life-years (QALYs), costs, anticoagulation therapy, stroke incidence, and hemorrhage risks.
Main Results:
- Both ECG and pulse palpation screening were more effective and costlier than no screening.
- Incremental cost-effectiveness ratios were approximately $8,000/QALY (males) and $10,000/QALY (females).
- Screening programs showed similar effectiveness and costs; results were sensitive to stroke incidence and anticoagulant prescription rates.
Conclusions:
- Annual ECG and pulse palpation screening for AF are cost-effective strategies in Japan.
- These screening methods are favorable for preventing ischaemic stroke associated with AF.
- Both screening approaches align with conventional cost-effectiveness criteria.
Objectives:
To examine the cost-effectiveness of a community-based screening programme for chronic atrial fibrillation (AF) in Japan.
Methods:
Using a computer model of a Markov process, the cost-effectiveness of an annual ECG screening programme and an annual pulse palpation screening programme for arrhythmia were compared with no screening. A hypothetical Japanese population of 65 year old individuals was followed until 85 years of age. We assumed that individuals with irregular beats on palpation were worked up by ECG and that ECG was perfect in detecting AF, whereas palpation was not. It was also assumed that patients diagnosed with AF received anticoagulant therapy, that some AF patients developed ischaemic stroke, and that some on anticoagulant therapy developed intracranial or gastrointestinal haemorrhage. Costs, efficacy of anticoagulation, utility of health status, and clinical variables were estimated from the literature. Outcomes were expressed as US dollars per quality-adjusted life-year (QALY).
Results:
Both annual ECG screening programme and annual palpation screening programme were more costly and at the same time more effective compared with no screening, with their incremental cost-effectiveness ratios approximately US$8000 per QALY in males and US$10,000 per QALY in females. Sensitivity analyses showed high sensitivity of cost-effectiveness ratios to the incidence of ischaemic stroke and anticoagulants prescription rate. Two annual screening programmes were similar in effectiveness and costs.
Conclusion:
To prevent ischaemic stroke associated with AF, both annual ECG screening and annual palpation screening were favourable in the context of conventional criteria for cost-effectiveness.
