Patrick S Moran1, Conor Teljeur2, Patricia Harrington3, Susan M Smith4, Breda Smyth5, Joseph Harbison6, Charles Normand7, Máirín Ryan8. 1. Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland; Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland. Electronic address: moranps@tcd.ie. 2. Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland; Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland. 3. Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland. 4. Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland. 5. Department of Public Health, Health Service Executive, Merlin Park University Hospital, Galway, Ireland. 6. Trinity College Dublin Health Sciences Centre, St James's Hospital, Dublin, Ireland. 7. Department of Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland. 8. Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
Abstract
OBJECTIVES: To evaluate the cost-effectiveness of a national atrial fibrillation screening program in Ireland involving annual opportunistic pulse palpation of all those older than 65 years during general practitioner consultations, with an electrocardiogram being performed if an irregular pulse is detected. METHODS: A probabilistic Markov model was used to simulate costs and clinical outcomes in a hypothetical cohort of men and women with and without screening over the course of 25 years, using a societal perspective. RESULTS: Screening was associated with an incremental cost-effectiveness ratio of €23,004/quality-adjusted life-year compared with routine care. Nevertheless, if the relative risk of stroke and systematic embolism in screen-detected patients is more than 12% lower than that in patients with atrial fibrillation identified through routine practice, then screening would not be considered cost-effective at a willingness-to-pay threshold of €45,000/quality-adjusted life-year. An analysis comparing alternative combinations of start age and screening interval found that less frequent screening with a later start age may be more cost-effective than an annual screening from age 65 years. CONCLUSIONS: Annual opportunistic screening of men and women aged 65 years and older in primary care in Ireland is likely to be cost-effective using conventional willingness-to-pay thresholds, assuming that those detected through screening have a comparable stroke risk profile as those detected through routine practice. Raising the start age of screening or increasing the screening interval may improve the cost-effectiveness of a prospective screening program.
OBJECTIVES: To evaluate the cost-effectiveness of a national atrial fibrillation screening program in Ireland involving annual opportunistic pulse palpation of all those older than 65 years during general practitioner consultations, with an electrocardiogram being performed if an irregular pulse is detected. METHODS: A probabilistic Markov model was used to simulate costs and clinical outcomes in a hypothetical cohort of men and women with and without screening over the course of 25 years, using a societal perspective. RESULTS: Screening was associated with an incremental cost-effectiveness ratio of €23,004/quality-adjusted life-year compared with routine care. Nevertheless, if the relative risk of stroke and systematic embolism in screen-detected patients is more than 12% lower than that in patients with atrial fibrillation identified through routine practice, then screening would not be considered cost-effective at a willingness-to-pay threshold of €45,000/quality-adjusted life-year. An analysis comparing alternative combinations of start age and screening interval found that less frequent screening with a later start age may be more cost-effective than an annual screening from age 65 years. CONCLUSIONS: Annual opportunistic screening of men and women aged 65 years and older in primary care in Ireland is likely to be cost-effective using conventional willingness-to-pay thresholds, assuming that those detected through screening have a comparable stroke risk profile as those detected through routine practice. Raising the start age of screening or increasing the screening interval may improve the cost-effectiveness of a prospective screening program.
Authors: Jonas Hald; Peter Bo Poulsen; Ina Qvist; Lisbeth Holm; Dorte Wedell-Wedellsborg; Lars Dybro; Lars Frost Journal: PLoS One Date: 2017-11-13 Impact factor: 3.240
Authors: Mustafa Oguz; Tereza Lanitis; Xiaoyan Li; Gail Wygant; Daniel E Singer; Keith Friend; Patrick Hlavacek; Andreas Nikolaou; Soeren Mattke Journal: Appl Health Econ Health Policy Date: 2020-08 Impact factor: 2.561
Authors: Nicole Lowres; Jake Olivier; Tze-Fan Chao; Shih-Ann Chen; Yi Chen; Axel Diederichsen; David A Fitzmaurice; Juan Jose Gomez-Doblas; Joseph Harbison; Jeff S Healey; F D Richard Hobbs; Femke Kaasenbrood; William Keen; Vivian W Lee; Jes S Lindholt; Gregory Y H Lip; Georges H Mairesse; Jonathan Mant; Julie W Martin; Enrique Martín-Rioboó; David D McManus; Javier Muñiz; Thomas Münzel; Juliet Nakamya; Lis Neubeck; Jessica J Orchard; Luis Ángel Pérula de Torres; Marco Proietti; F Russell Quinn; Andrea K Roalfe; Roopinder K Sandhu; Renate B Schnabel; Breda Smyth; Apurv Soni; Robert Tieleman; Jiguang Wang; Philipp S Wild; Bryan P Yan; Ben Freedman Journal: PLoS Med Date: 2019-09-25 Impact factor: 11.069