Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia.
Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia.
Heart Lung Circ. 2023 Jun;32(6):678-695. doi: 10.1016/j.hlc.2023.03.014. Epub 2023 Apr 24.
Screening for Atrial Fibrillation (AF) is recommended for people aged above 65 years. Screening for AF in asymptomatic individuals can be beneficial by enabling earlier diagnosis and the commencement of interventions to reduce the risk of early events, thus improving patient outcomes. This study systematically reviews the literature about the cost-effectiveness of various screening methods for previously undiagnosed AF.
Four databases were searched to identify articles that are cost-effectiveness studies conducted on screening for AF published from January 2000 to August 2022. The Consolidated Health Economic Evaluation Reporting Standards 2022 checklist was used to assess the quality of the selected studies. A previously published approach was used to assess the usefulness of each study for health policy makers.
The database search yielded 799 results, with 26 articles meeting the inclusion criteria. Articles were categorised into four subgroups: (i) population screening, (ii) opportunistic screening, (iii) targeted, and (iv) mixed methods of screening. Most of the studies screened adults ≥65 years of age. Most studies were performed from a 'health care payer perspective' and almost all studies used 'not screening' as a comparator. Almost all screening methods assessed were found to be cost-effective in comparison to 'not screening'. The reporting quality varied between 58% to 89%. The majority of the studies were found to be of limited usefulness for health policy makers, as none of the studies made any clear statements about policy change or implementation direction.
All approaches of AF screening were found to be cost-effective compared with no screening, while opportunistic screening was found to be the optimal approach in some studies. However, screening for AF in asymptomatic individuals is context specific and likely to be cost-effective depending on the population screened, screening approach, frequency, and the duration of screening.
建议对年龄在 65 岁以上的人群进行心房颤动（AF）筛查。对无症状个体进行 AF 筛查可以通过早期诊断和开始干预措施来降低早期事件的风险，从而改善患者的预后。本研究系统地回顾了关于用于筛查先前未诊断的 AF 的各种筛查方法的成本效益的文献。
我们检索了四个数据库，以确定 2000 年 1 月至 2022 年 8 月发表的关于筛查 AF 的成本效益研究。使用 2022 年的《卫生保健经济评估报告标准》核对表来评估所选研究的质量。使用以前发表的方法来评估每个研究对卫生政策制定者的有用性。
数据库搜索产生了 799 项结果，其中有 26 篇文章符合纳入标准。文章分为四组：（i）人群筛查、（ii）机会性筛查、（iii）靶向筛查和（iv）混合筛查方法。大多数研究筛查了年龄在 65 岁以上的成年人。大多数研究从“医疗保健支付者的角度”进行，几乎所有研究都将“不筛查”作为对照。与“不筛查”相比，几乎所有评估的筛查方法都被认为是具有成本效益的。报告质量在 58%到 89%之间。大多数研究对卫生政策制定者的实用性有限，因为没有一项研究对政策变化或实施方向做出明确的声明。
与不筛查相比，所有 AF 筛查方法都被认为是具有成本效益的，而在一些研究中，机会性筛查被认为是最佳方法。然而，对无症状个体进行 AF 筛查是具体情况具体分析的，并且取决于筛查的人群、筛查方法、频率以及筛查的持续时间，可能是具有成本效益的。
