Is Screening For Atrial Fibrillation In Canadian Family Practices Cost-Effective In Patients Sixty-Five Years And Older?

We present an economic evaluation of a recently completed cohort study which screened 2,054 seniors for atrial fibrillation (AF) in 22 Canadian family practices (FPs). Using a Markov model, trial and literature data were used to project long-term outcomes and costs associated with four AF screening strategies for individuals aged 65 years or older: no screening, screen with 30-s radial manual pulse check (pulse check), screen with a blood pressure machine with AF detection (BP-AF) and screen with a single-lead ECG (SL-ECG). Costs and outcomes were discounted at 1.5% and the model uses a lifetime horizon from public payer perspective. Compared to no screening, screening for AF in Canadian FP offices using pulse check or BP-AF is the dominant strategy while screening with SL-ECG is a highly cost-effective strategy with an incremental cost per quality-adjusted life-year (QALY) gained of $4,788. When comparing different screening strategies, screening with pulse check had the lowest expected costs ($202) and screening with SL-ECG had the highest expected costs ($222). The no screening arm resulted in the lowest number of QALYs (8.74195) while pulse check and SL-ECG resulted in the highest expected QALYs (8.74362). Probabilistic analysis confirmed that pulse check has the highest probability of being cost-effective (63%) assuming a willingness-to-pay of $50,000 per QALY gained. Screening for AF in seniors during routine appointments with Canadian family physicians is a cost-effect...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research