title: Cost-Effectiveness of a National Opportunistic Screening Program for Atrial Fibrillation in Ireland.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of a national atrial fibrillation screening program in Ireland involving annual opportunistic pulse palpation of all those older than 65 years during general practitioner consultations, with an electrocardiogram being performed if an irregular pulse is detected.
  
  
  METHODS
  A probabilistic Markov model was used to simulate costs and clinical outcomes in a hypothetical cohort of men and women with and without screening over the course of 25 years, using a societal perspective.
  
  
  RESULTS
  Screening was associated with an incremental cost-effectiveness ratio of €23,004/quality-adjusted life-year compared with routine care. Nevertheless, if the relative risk of stroke and systematic embolism in screen-detected patients is more than 12% lower than that in patients with atrial fibrillation identified through routine practice, then screening would not be considered cost-effective at a willingness-to-pay threshold of €45,000/quality-adjusted life-year. An analysis comparing alternative combinations of start age and screening interval found that less frequent screening with a later start age may be more cost-effective than an annual screening from age 65 years.
  
  
  CONCLUSIONS
  Annual opportunistic screening of men and women aged 65 years and older in primary care in Ireland is likely to be cost-effective using conventional willingness-to-pay thresholds, assuming that those detected through screening have a comparable stroke risk profile as those detected through routine practice. Raising the start age of screening or increasing the screening interval may improve the cost-effectiveness of a prospective screening program.
authors.affiliation: Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland; Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland. Electronic address: moranps@tcd.ie.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Moran
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland; Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.
authors.forename: Conor
authors.initials: C
authors.lastname: Teljeur
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Harrington
authors.affiliation: Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Department of Public Health, Health Service Executive, Merlin Park University Hospital, Galway, Ireland.
authors.forename: Breda
authors.initials: B
authors.lastname: Smyth
authors.affiliation: Trinity College Dublin Health Sciences Centre, St James's Hospital, Dublin, Ireland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Harbison
authors.affiliation: Department of Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
authors.forename: Máirín
authors.initials: M
authors.lastname: Ryan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics; D006801:Humans; D015994:Incidence; D007494:Ireland; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D011320:Primary Health Care; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D020521:Stroke / Q000191:economics* / Q000209:etiology* / Q000517:prevention & control; D015599:Trauma Severity Indices
chemical_list: D005343:Fibrinolytic Agents
keywords: atrial fibrillation; pulse palpation; screening; stroke