Cost-effectiveness analysis of screening for atrial fibrillation in pharmacies using an iPhone handheld ECG (SEARCH-AF).

Lowres, N; Salkeld, G; Neubeck, Lis; Martinez, C.; Wallenhorst, C; Freedman, S B

Abstract

Purpose: Identifying unknown atrial fibrillation (AF) in the community and subsequent anti-thrombotic treatment could reduce stroke burden. We aimed to determine the cost-effectiveness of community screening for unknown AF, using an iPhone ECG with an automated algorithm (iECG) in pharmacies.

Methods: Cost-effectiveness analysis from an Australian health funder perspective comparing cost of iECG population-based AF screening, to diagnosed AF in an unscreened population, for age 65-84. Results are expressed as incremental cost-effectiveness ratio (ICER) per stroke avoided and per quality adjusted life year (QALY) gained. The model assumed a rate of unknown AF of 1.4% in target population; test sensitivity 97%; test specificity 92%; cost of warfarin treatment and monitoring $AUD803.80 (€421.73) pa; cost per screen $AUD20 (€10.49); and 5.09 QALYs gained per stroke avoided. Benefits of detecting AF are based on data obtained from the UK Clinical Practice Research Datalink using a subset of 5,567 patients with incidentally detected asymptomatic AF, with incidence rates projected out to 10 years following initial screen. Sensitivity analyses varied base assumptions for anticoagulant guideline-adherence rate.

Results: The ICER of extending iECG screening into the community, based on 55% warfarin prescription adherence, would be $AUD5,951 (€3,122) per QALY gained and $AUD30,290 (€15,892) for prevention of one stroke. Sensitivity analysis indicated cost-effectiveness improved with increased treatment adherence.

Conclusions: Screening with iECG in pharmacies is cost effective for stroke prevention and gaining QALY, and well within a range fundable on a population basis, using either warfarin or novel oral anticoagulants. Guideline recommendation of community iECG screening for AF should be considered.

Citation

Lowres, N., Salkeld, G., Neubeck, L., Martinez, C., Wallenhorst, C., & Freedman, S. B. (2014). Cost-effectiveness analysis of screening for atrial fibrillation in pharmacies using an iPhone handheld ECG (SEARCH-AF). European Heart Journal, 35, 1032

• Journal Article Type: Article
• Online Publication Date: Dec 1, 2014
• Publication Date: 2014
• Deposit Date: Dec 5, 2016
• Print ISSN: 0195-668X
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Pages: 1032
• Keywords: Atrial fibrillation, screening, ECG,
• Public URL: http://researchrepository.napier.ac.uk/Output/448326
• Related Public URLs: https://esc365.escardio.org/Congress/ESC-CONGRESS-2014/Risk-assessment-in-atrial-fibrillation-what-really-matters/101617-cost-effectiveness-analysis-of-screening-for-atrial-fibrillation-in-pharmacies-using-an-iphone-handheld-ecg-search-af#abstract