Cost-effectiveness of targeted screening for non-valvular atrial fibrillation in the United Kingdom in older patients using digital approaches

by Selleckchem | Feb 27 2023

Aim: Screening for non-valvular atrial fibrillation (NVAF) is key in identifying patients with undiagnosed disease who may be eligible for anticoagulation therapy. Understanding the economic value of screening is necessary to assess optimal strategies for payers and healthcare systems. We evaluated cost effectiveness of opportunistic screening with handheld digital devices and pulse palpation, as well as targeted screening predictive algorithms for UK patients ≥75 years of age.

Methods: A previously developed Markov cohort model was adapted to evaluate clinical and economic outcomes of opportunistic screening including pulse palpation, Zenicor (extended 14 days), KardiaMobile (extended), and two algorithms compared to no screening. Key model inputs including epidemiology estimates, screening effectiveness, and risks for medical events were derived from the STROKESTOP, ARISTOTLE studies, and published literature, and cost inputs were obtained from a UK national cost database. Health and cost outcomes, annually discounted at 3.5%, were reported for a cohort of 10,000 patients vs. no screening over a time horizon equivalent to a patient's lifetime, Analyses were performed from a UK National Health Services and personal social services perspective.

Results: Zenicor, pulse palpation, and KardiaMobile were dominant (providing better health outcomes at lower costs) vs. no screening; both algorithms were cost-effective vs. no screening, with an incremental cost-effectiveness ratios per quality-adjusted life-year (QALY) of £1,040 and £1,166. Zenicor, pulse palpation, and KardiaMobile remained dominant options vs. no screening in all scenarios explored. Deterministic sensitivity analyses indicated long-term stroke care costs, prevalence of undiagnosed NVAF in patients 75-79 years of age, and clinical efficacy of anticoagulant on stroke prevention were the main drivers of the cost effectiveness results.

Conclusions: Screening for NVAF at ≥75 years of age could result in fewer NVAF-related strokes. NVAF screening is cost-effective and may be cost-saving depending on the program chosen.

Comments：

The study concluded that screening for non-valvular atrial fibrillation (NVAF) in patients aged 75 years or older in the UK is cost-effective. The study found that using handheld digital devices such as Zenicor, pulse palpation, and KardiaMobile, and targeted screening predictive algorithms, were dominant (providing better health outcomes at lower costs) compared to no screening. Both algorithms were also cost-effective compared to no screening, with an incremental cost-effectiveness ratio per quality-adjusted life-year of £1,040 and £1,166. The results of the deterministic sensitivity analyses indicated that long-term stroke care costs, prevalence of undiagnosed NVAF in patients aged 75-79 years, and clinical efficacy of anticoagulant on stroke prevention were the main drivers of the cost-effectiveness results. In conclusion, NVAF screening could result in fewer NVAF-related strokes and is cost-effective, potentially even cost-saving, depending on the program chosen.