Andrade Jason G, Shah Anshul, Godin Richard, Lanitis Tereza, Kongnakorn Thitima, Brown Lauren, Dhanda Devender, Dhamane Amol, Nault Isabelle
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada.
Heart Rhythm O2. 2022 Nov 17;4(2):103-110. doi: 10.1016/j.hroo.2022.11.003. eCollection 2023 Feb.
Contemporary guidelines recommend opportunistic screening for atrial fibrillation (AF).
The objective of this study was to assess the cost-effectiveness of single time point opportunistic AF screening for patients 65 years and older by using the single-lead electrocardiogram.
An established Markov cohort model was adapted by updating the background mortality estimates, epidemiology, screening efficacy, treatment patterns, resource use, and cost inputs to reflect a Canadian health care setting. Inputs were derived from a contemporary prospective screening study performed in Canadian primary care settings (screening efficacy and epidemiology) and the published literature (unit costs, epidemiology, mortality, utility, and treatment efficacy). The impact of screening and oral anticoagulant treatment on the cost and clinical outcomes was analyzed. A Canadian payer perspective over lifetime was used for analysis, with costs expressed in 2019 Canadian dollars.
Among the estimated screening-eligible population of 2,929,301 patients, the screening cohort identified an additional 127,670 AF cases compared with the usual care cohort. The model estimated avoidance of 12,236 strokes and incremental quality-adjusted life-years of 59,577 (0.02 per patient) over lifetime in the screening cohort. Cost savings were substantial because of improved health outcomes, reflecting screening being the dominant strategy (affordable and effective). Model results were robust across sensitivity and scenario analyses.
Single time point opportunistic screening of AF using a single-lead electrocardiogram device in Canadian patients 65 years and older without known AF may provide improved health outcomes with cost savings from the perspective of a single payer health care environment.
当代指南推荐对心房颤动（AF）进行机会性筛查。
本研究的目的是通过使用单导联心电图评估对65岁及以上患者进行单时间点机会性AF筛查的成本效益。
通过更新背景死亡率估计、流行病学、筛查效果、治疗模式、资源使用和成本投入来调整已建立的马尔可夫队列模型，以反映加拿大的医疗保健环境。数据来源于在加拿大初级保健机构进行的当代前瞻性筛查研究（筛查效果和流行病学）以及已发表的文献（单位成本、流行病学、死亡率、效用和治疗效果）。分析了筛查和口服抗凝治疗对成本和临床结局的影响。分析采用加拿大支付方在患者终身的视角，成本以2019年加拿大元表示。
在估计的2929301例符合筛查条件的患者中，与常规护理队列相比，筛查队列额外发现了127670例AF病例。该模型估计筛查队列终身可避免12236例中风，增加质量调整生命年59577个（每位患者0.02个）。由于健康结局改善，成本节约显著，表明筛查是主要策略（经济有效）。模型结果在敏感性和情景分析中均稳健。
从单一支付方医疗保健环境的角度来看，对65岁及以上无已知AF的加拿大患者使用单导联心电图设备进行单时间点机会性AF筛查可能会改善健康结局并节省成本。
