title: A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.
abstract: OBJECTIVE
  The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.
  
  
  RESULTS
  The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.
  
  
  CONCLUSIONS
  Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden lars-ake.levin@liu.se.
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Husberg
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Piotr Doliwa
authors.initials: PD
authors.lastname: Sobocinski
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Viveka Frykman
authors.initials: VF
authors.lastname: Kull
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Friberg
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidson
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D003362:Cost-Benefit Analysis; D004562:Electrocardiography / Q000191:economics; D015716:Electrocardiography, Ambulatory / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics; D020521:Stroke / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D013548:Sweden
keywords: Atrial fibrillation; Cost-effectiveness; Ischaemic stroke; QALY; Screening; Secondary prevention