Cost-effectiveness of screening for atrial fibrillation in a single primary care center at a 3-year follow-up

Objectives The aim of this study was to estimate the cost-effectiveness of intermittent electrocardiogram (ECG) screening for atrial fibrillation (AF) among 70-74-year old individuals in primary care. We also aimed to assess adherence to anticoagulants, severe bleeding, stroke and mortality among screening-detected AF cases at three-year follow-up. Methods A post hoc analysis based on a cross-sectional screening study for AF among 70-74-year old patients, who were registered at a single primary care center, was followed for three years for mortality. Data about adherence to anticoagulants, incidence of stroke and severe bleeding among screening-detected AF cases, were collected from patients records. Markov model and Monte Carlo simulation were used to assess the cost-effectiveness of the screening program. Results The mortality rate among screening-detected AF cases (n = 16) did not differ compared to the 274 individuals with no AF (hazard ratio 0.86, CI 0.12-6.44). Adherence to anticoagulants was 92%. There was no stroke or severe bleeding. The incremental cost-effectiveness ratio of screening versus no screening was EUR 2389/quality-adjusted life year (QALY) gained. The screening showed a 99% probability of being cost-effective compared to no screening at a willingness-to-pay threshold of EUR 20,000 per QALY. Conclusion Screening for AF among 70-74-year olds in primary care using intermittent ECG appears to be cost-effective at 3-year follow-up with high anticoagulants adherence and no increased mortality.Funding: M. R. has received research grants, lecture and consulting honoraria from the following sources. Abbott, Carl Bennett AB, Bristol Myers Squibb, Medtronic, MSD, Pfizer, Roche, Sanofi, and Zenicor. L. L. has received economic support for lecturing, advisory boards and research from AstraZeneca, Bayer, Boehringer Ingelheim and Pfizer. F. A. has received lecture fees from Bristol-Myers-Squibb, Pfizer, Boehringer-Ingelheim, and Bayer. M. A. employed by AstraZeneca.