Pfizer Denmark, Health & Value, Lautrupvang 8, DK-2750 Ballerup, Denmark.
Department of Cardiology, University Research Clinic for Innovative Patient Pathways, Regional Hospital of Silkeborg, Falkevej 1A, DK-8600 Silkeborg, Denmark.
Eur Heart J Qual Care Clin Outcomes. 2022 Mar 2;8(2):177-186. doi: 10.1093/ehjqcco/qcaa092.
The objective was to evaluate the cost-effectiveness of one-time opportunistic screening for atrial fibrillation (AF) in general practice in citizens aged ≥65 years in Denmark compared to a no-screening alternative following current Danish practice.
A decision tree and a Markov model were designed to simulate costs and quality-adjusted life years (QALYs) in a hypothetical cohort of citizens aged ≥65 years equivalent to the Danish population (1 M citizens) over the course of 19 years, using a healthcare and societal perspective. Share of detected AF patients following opportunistic screening was retrieved from a recent Danish screening study, whereas the risk stroke and bleedings in AF patients were based on population data from national registries and their associated costs was obtained from published national registry studies. The present study showed that one-time opportunistic screening for AF was more costly, but also more effective compared to a no-screening alternative. The analysis predicts that one-time opportunistic screening of all Danes aged ≥65 years potentially can identify an additional 10 300 AF patients and prevent 856 strokes in the period considered. The incremental cost of such a screening programme is €56.4 M, with a total gain of 6000 QALYs, resulting in an incremental cost-effectiveness ratio of €9400 per QALY gained.
Opportunistic screening in general practice in citizens aged ≥65 years in Denmark is cost-effective compared to a willingness-to-pay threshold of €22 000. The study and its findings support a potential implementation of opportunistic screening for AF at the general practitioner level in Denmark.
本研究旨在评估丹麦≥65 岁普通人群中单次机会性房颤（AF）筛查相对于当前丹麦实践中不筛查的成本效益。
本研究采用决策树和马尔可夫模型，以丹麦≥65 岁的假设人群（100 万居民）为基础，从医疗保健和社会角度，模拟 19 年的成本和质量调整生命年（QALY）。从最近的丹麦筛查研究中获取机会性筛查后发现的 AF 患者比例，而 AF 患者的中风和出血风险则基于全国登记数据和相关成本则来自已发表的全国登记研究。本研究表明，与不筛查相比，单次机会性 AF 筛查的成本更高，但效果也更好。分析预测，对所有≥65 岁的丹麦人进行一次性机会性筛查，可能会在研究期间额外发现 10300 例 AF 患者，并预防 856 例中风。这样的筛查计划的增量成本为 5640 万欧元，总增益为 6000 个 QALY，增量成本效益比为每获得一个 QALY 增加 9400 欧元。
与 22000 欧元的意愿支付阈值相比，丹麦≥65 岁普通人群中的机会性筛查在成本效益上是合理的。本研究及其结果支持在丹麦的全科医生层面实施 AF 机会性筛查。
