Designing an optimal screening program for unknown atrial fibrillation: a cost-effectiveness analysis.
OBJECTIVE
The primary objective of this study was to use computer simulations to suggest an optimal age for initiation of screening for unknown atrial fibrillation and to evaluate if repeated screening will add value.


RESULTS
In the absence of relevant clinical studies, this analysis was based on a simulation model. More than two billion different designs of screening programs for unknown atrial fibrillation were simulated and analysed. Data from the published scientific literature and registries were used to construct the model and estimate lifelong effects and costs. Costs and effects generated by 2 147 483 648 different screening designs were calculated and compared. Program designs that implied worse clinical outcome and were less cost-effective compared to other programs were excluded from the analysis. Seven program designs were identified, and considered to be cost effective depending on what the health-care decision makers are ready to pay for gaining a quality-adjusted life-year (QALY). Screening at the age of 75 implied the lowest cost per gained QALY (€4 800/QALY).


CONCLUSIONS
In conclusion, examining the results of more than two billion simulated screening program designs for unknown atrial fibrillation, seven designs were deemed cost-effective depending on how much we are prepared to pay for gaining QALYs. Our results showed that repeated screening for atrial fibrillation implied additional health benefits to a reasonable cost compared to one-off screening.
Department of Medical and Health Sciences, Linkoping University, SE-581 83 Linkoping, Sweden.
Mattias
M
Aronsson
Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
Emma
E
Svennberg
Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
Mårten
M
Rosenqvist
Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
Johan
J
Engdahl
Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
Faris
F
Al-Khalili
Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
Leif
L
Friberg
Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden.
Viveka
V
Frykman
Department of Medical and Health Sciences, Linkoping University, SE-581 83 Linkoping, Sweden.
Lars-Åke
LÅ
Levin
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D000066491:Clinical Decision-Making; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004562:Electrocardiography / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D013997:Time Factors
Atrial fibrillation; Cost-utility analysis; Optimization analysis; Screening