A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.
AIMS
The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.


METHODS AND RESULTS
The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.


CONCLUSION
Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.
['Levin|Lars-Åke|LÅ|', 'Husberg|Magnus|M|', 'Sobocinski|Piotr Doliwa|PD|', 'Kull|Viveka Frykman|VF|', 'Friberg|Leif|L|', 'Rosenqvist|Mårten|M|', 'Davidson|Thomas|T|']
D000368:Aged D058070:Asymptomatic Diseases D001281:Atrial Fibrillation D002545:Brain Ischemia D003362:Cost-Benefit Analysis D004562:Electrocardiography D015716:Electrocardiography, Ambulatory D006801:Humans D008390:Markov Chains D008403:Mass Screening D019057:Quality-Adjusted Life Years D055502:Secondary Prevention D020521:Stroke D013548:Sweden
Cost-effectiveness Screening Atrial fibrillation Ischaemic stroke QALY Secondary prevention