Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study. (9th November 2022)

• Record Type: Journal Article
• Authors: Lyth, Johan; Svennberg, Emma; Bernfort, Lars; Aronsson, Mattias; Frykman, Viveka; Al-Khalili, Faris; Friberg, Leif; Rosenqvist, Mårten; Engdahl, Johan; Levin, Lars-Åke
• Is Part Of: European heart journal. Volume 44:Number 3(2023)
• Page Start: 196
• Page End: 204
• Publication Date: 2022-11-09
• Subjects: Atrial fibrillation -- Screening -- Stroke prevention -- Cost-effectiveness -- Markov modelling; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac547
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. Methods and results: The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 individuals invited to the screening, there were 77 gained life years and 65 gained quality-adjusted life years. The incremental cost was €1.77 million lower in the screening invitation group. Gained quality-adjusted life years to a lower cost means that the screening strategy was dominant. The result from 10 000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1000 individuals resulted in 10.6 [95% confidence interval (CI): −22.5 to 1.4] fewer strokes (8.4 ischaemic and 2.2 haemorrhagic strokes), 1.0 (95% CI: −1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI: −18.2 to 13.1) fewer bleedings associated with hospitalization. Conclusion: Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation. Structured Graphical Abstract: Structured Graphical Abstract QALY, quality-adjusted life year.