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Cost-Effectiveness of Atrial Fibrillation Screening Strategies: A Systematic Review
Hassan Abolghasem Gorji1, Majid Khosravi1, Razieh Mahmoodi1
1Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Insights
Screening for atrial fibrillation (AF) is cost-effective, particularly population-based strategies. This review analyzed 15 studies, finding varied cost-effectiveness ratios for different AF screening methods and populations.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia.
- AF significantly increases the risk of stroke.
- Systematic review of AF screening cost-effectiveness is crucial.
Purpose of the Study:
- To systematically review the cost-effectiveness of various screening strategies for atrial fibrillation (AF).
- To identify optimal screening approaches for AF detection and stroke prevention.
Main Methods:
- Comprehensive search of Iranian and international databases until December 2020.
- Inclusion/exclusion criteria applied to 3,360 identified studies.
- Analysis of main outcomes: incremental cost-effectiveness ratios (ICER), quality-adjusted life years (QALYs), cases detected, and avoided strokes.
Main Results:
- Fifteen studies were included in the final analysis.
- ICER values ranged from 78.39 (ECG screening for Japanese women aged 65-85) to 70,864.31 (prolonged ECG for Canadians over 80).
- Results were reported using ICER, QALYs, and years of life gained (YLG).
Conclusions:
- Most reviewed studies support the cost-effectiveness of various AF screening strategies.
- Population-based screening approaches demonstrated stronger evidence of cost-effectiveness compared to other methods.
Background:
Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF is associated with an increased risk of stroke. We aimed to review systematically the cost-effectiveness of screening strategies for patients with AF.
Methods:
To find related research and articles, articles published in Iranian and international databases by using a combination of MeSH (Medical Subject Headings) terms and based on inclusion and exclusion criteria were searched and reviewed until Dec 2020. The main outcome measures of the final articles were incremental cost-effectiveness ratios (ICER) per gained or additional quality-adjusted life years (QALYs), additional case detected, and avoided stroke.
Results:
Out of 3,360 studies found, finally, fifteen studies were included in the research. The lowest ICER numerical value was 78.39 for AF screening using ECG for 65-85 yr old Japanese women. The highest value of this index is equal to 70864.31 for performing ECG monitoring for more than 60 d for Canadians over 80 yr without AF history. In two studies, the results were expressed with the years of life gained (YLG measure. Of course, in one study, the results were not reported with this measure, and in one study, the results were reported with ICER.
Conclusion:
Most of the studies acknowledged the cost-effectiveness of different AF screening strategies. However, studies that confirmed the cost-effectiveness of population-based screening were more than studies that confirmed the cost-effectiveness of other screening strategies.
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