Cost-Effectiveness of Atrial Fibrillation Screening Strategies: A Systematic Review
-
Hassan Abolghasem Gorji
,
Majid Khosravi
,
Razieh Mahmoodi
,
Mojtaba Hasoumi
,
Aghdas Souresrafil
,
Vahid Alipour
,
Aziz Rezapour
,
Marjan Hajahmadi
,
Samad Azari
Abstract
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.
1. Chugh SS, Havmoeller R, Narayanan K, et al et al (2014). Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 129(8):837-47.
2. Fitzmaurice DA, Hobbs FR, Jowett S, et al (2007). Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ, 335(7616):383.
3. Fuster V, Rydén LE, Cannom DS, et al (2006). Acc/aha/esc 2006 guidelines for the management of patients with atrial fibrillation: A report of the american college of cardiology/american heart association task force on practice guidelines and the european society of cardiology committee for practice guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation): Developed in collaboration with the european heart rhythm association and the heart rhythm society. Circulation, 114(7):e257-e354.
4. Schnabel RB, Yin X, Gona P, et al (2015). 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet, 386(9989):154-62.
5. Fordyce CB, Roe MT, Ahmad T, et al (2015). Cardiovascular drug development: is it dead or just hibernating?. J Am Coll Cardiol, 65(15):1567-82.
6. Hunink MG, Goldman L, Tosteson AN, et al (1997). The recent decline in mortality from coronary heart disease, 1980-1990: the effect of secular trends in risk factors and treatment. JAMA, 277(7):535-42.
7. Majeed A, Moser K, Carroll K (2001). Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart, 86(3):284-8.
8. Krijthe BP, Kunst A, Benjamin EJ, et al (2013). Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J, 34(35):2746-51.
9. Dilaveris PE, Kennedy HL (2017). Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol, 40(6):413-8.
10. Savelieva I, Camm AJ (2000). Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol,4:369-82.
11. Lowres N, Neubeck L, Redfern J, Freedman SB (2013). Screening to identify unknown atrial fibrillation. Thromb Haemost, 110(08):213-22.
12. Cowan JC, Wu J, Hall M, Orlowski A, West RM, Gale CP (2018). A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation. Eur Heart J, 39(32):2975-83.
13. Forslund T, Komen JJ, Andersen M, et al (2018). Improved stroke prevention in atrial fibrillation after the introduction of non–vitamin K antagonist oral anticoagulants: the Stockholm experience. Stroke,49(9):2122-8.
14. Hill NR, Sandler B, Mokgokong R, et al (2020). Cost-effectiveness of targeted screening for the identification of patients with atrial fibrillation: evaluation of a machine learning risk prediction algorithm. J Med Econ, 23(4):386-93.
15. Benjamin EJ, Chen PS, Bild DE, et al (2009). Prevention of atrial fibrillation: report from a national heart, lung, and blood institute workshop. Circulation, 119(4):606-18.
16. Jones NR, Taylor CJ, Hobbs FR, Bowman L, Casadei B (2020). Screening for atrial fibrillation: a call for evidence. Eur Heart J, 41(10):1075-85.
17. Curry SJ, Krist AH, Owens DK, et al (2018). Screening for atrial fibrillation with electrocardiography: US Preventive Services Task Force recommendation statement. JAMA, 320(5):478-84.
18. Aronsson M, Svennberg E, Rosenqvist M, et al (2015). Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording. Europace, 17(7):1023-9.
19. Tarride JE, Quinn FR, Blackhouse G, et al (2018). Is screening for atrial fibrillation in Canadian family practices cost-effective in patients 65 years and older?. Can J Cardiol, 34(11):1522-5.
20. Birkemeyer R, Müller A, Wahler S, von der Schulenburg JM. A cost-effectiveness analysis model of Preventicus atrial fibrillation screening from the point of view of statutory health insurance in Germany. Health Econ Rev, 10(1):1-8.
21. Hobbs FR, Fitzmaurice DA, Mant J, et al (2005). A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Health Technol Assess, 9(40):iii-iv, ix-x, 1-74.
22. Giebel GD (2020). Use of mHealth devices to screen for atrial fibrillation: cost-effectiveness analysis. JMIR Mhealth Uhealth, 8(10):e20496.
23. Jacobs MS, Kaasenbrood F, Postma MJ, van Hulst M, Tieleman RG (2018). Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands. Europace, 20(1):12-8.
24. Aronsson M, Carlsson P, Levin LÅ, Hager J, Hultcrantz R (2017). Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer. Br J Surg, 104(8):1078-86.
25. Oguz M, Lanitis T, Li X, et al (2020). Cost-effectiveness of extended and one-time screening versus no screening for non-valvular atrial fibrillation in the USA. Appl Health Econ Health Policy,18:533-45.
26. Orchard J, Li J, Freedman B, et al (2020). Atrial fibrillation screen, management, and guideline‐recommended therapy in the rural primary care setting: a cross‐sectional study and cost‐effectiveness analysis of ehealth tools to support all stages of screening. J Am Heart Assoc, 9(18):e017080.
27. Proietti M, Farcomeni A, Goethals P, et al (2019). Cost-effectiveness and screening performance of ECG handheld machine in a population screening programme: The Belgian Heart Rhythm Week screening programme. Eur J Prev Cardiol, 26(9):964-72.
28. Maeda K, Shimbo T, Fukui T (2004). Cost-effectiveness of a community-based screening programme for chronic atrial fibrillation in Japan. J Med Screen, 11(2):97-102.
29. Lowres N, Neubeck L, Salkeld G, et al (2014). Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. Thromb Haemost, 111(06):1167-76.
30. Levin LÅ, Husberg M, Sobocinski PD, et al (2015). A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace, 17(2):207-14.
31. Moran PS, Teljeur C, Harrington P, et al (2016). Cost-effectiveness of a national opportunistic screening program for atrial fibrillation in Ireland. Value Health, 19(8):985-95.
32. McIntyre WF, Yong JH, Sandhu RK, et al (2020). Prevalence of undiagnosed atrial fibrillation in elderly individuals and potential cost-effectiveness of non-invasive ambulatory electrocardiographic screening: The ASSERT-III study. J Electrocardiol, 58:56-60.
33. Welton NJ, McAleenan A, Thom HH, et al (2017). Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis. Health Technol Assess, 21(29).
34. guideline NG196 NI (2021). Atrial fibrillation: diagnosis and management. Available from: https://www.nice.org.uk/guidance/ng196
2. Fitzmaurice DA, Hobbs FR, Jowett S, et al (2007). Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ, 335(7616):383.
3. Fuster V, Rydén LE, Cannom DS, et al (2006). Acc/aha/esc 2006 guidelines for the management of patients with atrial fibrillation: A report of the american college of cardiology/american heart association task force on practice guidelines and the european society of cardiology committee for practice guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation): Developed in collaboration with the european heart rhythm association and the heart rhythm society. Circulation, 114(7):e257-e354.
4. Schnabel RB, Yin X, Gona P, et al (2015). 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet, 386(9989):154-62.
5. Fordyce CB, Roe MT, Ahmad T, et al (2015). Cardiovascular drug development: is it dead or just hibernating?. J Am Coll Cardiol, 65(15):1567-82.
6. Hunink MG, Goldman L, Tosteson AN, et al (1997). The recent decline in mortality from coronary heart disease, 1980-1990: the effect of secular trends in risk factors and treatment. JAMA, 277(7):535-42.
7. Majeed A, Moser K, Carroll K (2001). Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart, 86(3):284-8.
8. Krijthe BP, Kunst A, Benjamin EJ, et al (2013). Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J, 34(35):2746-51.
9. Dilaveris PE, Kennedy HL (2017). Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol, 40(6):413-8.
10. Savelieva I, Camm AJ (2000). Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol,4:369-82.
11. Lowres N, Neubeck L, Redfern J, Freedman SB (2013). Screening to identify unknown atrial fibrillation. Thromb Haemost, 110(08):213-22.
12. Cowan JC, Wu J, Hall M, Orlowski A, West RM, Gale CP (2018). A 10 year study of hospitalized atrial fibrillation-related stroke in England and its association with uptake of oral anticoagulation. Eur Heart J, 39(32):2975-83.
13. Forslund T, Komen JJ, Andersen M, et al (2018). Improved stroke prevention in atrial fibrillation after the introduction of non–vitamin K antagonist oral anticoagulants: the Stockholm experience. Stroke,49(9):2122-8.
14. Hill NR, Sandler B, Mokgokong R, et al (2020). Cost-effectiveness of targeted screening for the identification of patients with atrial fibrillation: evaluation of a machine learning risk prediction algorithm. J Med Econ, 23(4):386-93.
15. Benjamin EJ, Chen PS, Bild DE, et al (2009). Prevention of atrial fibrillation: report from a national heart, lung, and blood institute workshop. Circulation, 119(4):606-18.
16. Jones NR, Taylor CJ, Hobbs FR, Bowman L, Casadei B (2020). Screening for atrial fibrillation: a call for evidence. Eur Heart J, 41(10):1075-85.
17. Curry SJ, Krist AH, Owens DK, et al (2018). Screening for atrial fibrillation with electrocardiography: US Preventive Services Task Force recommendation statement. JAMA, 320(5):478-84.
18. Aronsson M, Svennberg E, Rosenqvist M, et al (2015). Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording. Europace, 17(7):1023-9.
19. Tarride JE, Quinn FR, Blackhouse G, et al (2018). Is screening for atrial fibrillation in Canadian family practices cost-effective in patients 65 years and older?. Can J Cardiol, 34(11):1522-5.
20. Birkemeyer R, Müller A, Wahler S, von der Schulenburg JM. A cost-effectiveness analysis model of Preventicus atrial fibrillation screening from the point of view of statutory health insurance in Germany. Health Econ Rev, 10(1):1-8.
21. Hobbs FR, Fitzmaurice DA, Mant J, et al (2005). A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Health Technol Assess, 9(40):iii-iv, ix-x, 1-74.
22. Giebel GD (2020). Use of mHealth devices to screen for atrial fibrillation: cost-effectiveness analysis. JMIR Mhealth Uhealth, 8(10):e20496.
23. Jacobs MS, Kaasenbrood F, Postma MJ, van Hulst M, Tieleman RG (2018). Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands. Europace, 20(1):12-8.
24. Aronsson M, Carlsson P, Levin LÅ, Hager J, Hultcrantz R (2017). Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer. Br J Surg, 104(8):1078-86.
25. Oguz M, Lanitis T, Li X, et al (2020). Cost-effectiveness of extended and one-time screening versus no screening for non-valvular atrial fibrillation in the USA. Appl Health Econ Health Policy,18:533-45.
26. Orchard J, Li J, Freedman B, et al (2020). Atrial fibrillation screen, management, and guideline‐recommended therapy in the rural primary care setting: a cross‐sectional study and cost‐effectiveness analysis of ehealth tools to support all stages of screening. J Am Heart Assoc, 9(18):e017080.
27. Proietti M, Farcomeni A, Goethals P, et al (2019). Cost-effectiveness and screening performance of ECG handheld machine in a population screening programme: The Belgian Heart Rhythm Week screening programme. Eur J Prev Cardiol, 26(9):964-72.
28. Maeda K, Shimbo T, Fukui T (2004). Cost-effectiveness of a community-based screening programme for chronic atrial fibrillation in Japan. J Med Screen, 11(2):97-102.
29. Lowres N, Neubeck L, Salkeld G, et al (2014). Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. Thromb Haemost, 111(06):1167-76.
30. Levin LÅ, Husberg M, Sobocinski PD, et al (2015). A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace, 17(2):207-14.
31. Moran PS, Teljeur C, Harrington P, et al (2016). Cost-effectiveness of a national opportunistic screening program for atrial fibrillation in Ireland. Value Health, 19(8):985-95.
32. McIntyre WF, Yong JH, Sandhu RK, et al (2020). Prevalence of undiagnosed atrial fibrillation in elderly individuals and potential cost-effectiveness of non-invasive ambulatory electrocardiographic screening: The ASSERT-III study. J Electrocardiol, 58:56-60.
33. Welton NJ, McAleenan A, Thom HH, et al (2017). Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis. Health Technol Assess, 21(29).
34. guideline NG196 NI (2021). Atrial fibrillation: diagnosis and management. Available from: https://www.nice.org.uk/guidance/ng196
| Files | ||
| Issue | Vol 52 No 4 (2023) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i4.12435 | |
| Keywords | ||
| Cost-effectiveness Economic evaluation Atrial fibrillation screening | ||
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How to Cite
1.
Gorji H, Khosravi M, Mahmoodi R, HasoumiM, SouresrafilA, Alipour V, Rezapour A, Hajahmadi M, Azari S. Cost-Effectiveness of Atrial Fibrillation Screening Strategies: A Systematic Review. Iran J Public Health. 2023;52(4):672-682.
