Fu Yu-Hua, Chao Tze-Fan, Yeh Yung-Hsin, Chan Yi-Hsin, Chien Hsiu-Ting, Chen Shih-Ann, Lin Fang-Ju
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
JACC Asia. 2024 Nov 26;5(1):160-171. doi: 10.1016/j.jacasi.2024.09.016. eCollection 2025 Jan.
Atrial fibrillation (AF) screening identifies undiagnosed patients who can benefit from anticoagulant therapy, thereby reducing the risk of ischemic stroke. However, the long-term outcomes and costs related to population screening for this purpose in the Asian elderly remain unknown.
This study aimed to evaluate the cost-effectiveness of population screening for AF in the elderly in Taiwan and explore the optimal screening strategy from the health care sector's perspective.
Using a Markov decision-analytic model, we simulated lifetime outcomes and costs of AF screening in a cohort of 10,000 individuals aged 75. Comparative analyses with a nonscreening approach assessed prevented ischemic strokes, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to address model uncertainty, while scenario analyses were performed to determine the optimal age and frequency of screening.
One-time population screening for AF among 75-year-olds prevented 45 ischemic strokes and gained 47.42 QALYs, with an additional cost of $592,450 (ICER: $12,493 per QALY gained). The cost-effectiveness of screening remained robust in sensitivity analyses, with anticoagulant effectiveness in ischemic stroke prevention being the most influential factor. Similar ICERs were observed for individuals aged 65 to 80 years. Implementing annual screening for individuals aged 65 to 80 years yielded an ICER of approximately $18,000 per QALY gained.
Both one-time and annual population screening for AF in individuals aged 65 to 80 years appear to be cost-effective. Further research is needed to assess budgetary and feasibility aspects to establish an optimal screening program.
心房颤动（房颤）筛查可识别出能从抗凝治疗中获益的未确诊患者，从而降低缺血性中风的风险。然而，在亚洲老年人中，为此目的进行人群筛查的长期结果和成本仍不明确。
本研究旨在评估台湾老年人群房颤筛查的成本效益，并从医疗保健部门的角度探索最佳筛查策略。
我们使用马尔可夫决策分析模型，模拟了10000名75岁人群房颤筛查的终身结果和成本。与非筛查方法进行比较分析，评估预防的缺血性中风、质量调整生命年（QALY）、成本和增量成本效益比（ICER）。进行敏感性分析以解决模型的不确定性，同时进行情景分析以确定最佳筛查年龄和频率。
对75岁人群进行一次性房颤人群筛查可预防45例缺血性中风，获得47.42个QALY，额外成本为592450美元（ICER：每获得一个QALY为12493美元）。在敏感性分析中，筛查的成本效益仍然稳健，其中抗凝剂在预防缺血性中风方面的有效性是最有影响的因素。65至80岁的个体观察到类似的ICER。对65至80岁的个体实施年度筛查，每获得一个QALY的ICER约为18000美元。
对65至80岁个体进行一次性和年度房颤人群筛查似乎都具有成本效益。需要进一步研究以评估预算和可行性方面，以建立最佳筛查计划。
