COST-EFFECTIVENESS ANALYSIS OF ATRIAL FIBRILLATION SCREENING FOR JAPANESE HYPERTENSIVE PATIENTS USING MICROSIMULATION...
Author(s)
Mitsuko Nakata, Ph.D.1, Keitaro Senoo, PhD2, Taku Okawa, MSc2.
1Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine, Kyoto, Japan.
1Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine, Kyoto, Japan.
OBJECTIVES: Non-valvular atrial fibrillation (NVAF) increases in prevalence with advancing age and is associated with a heightened risk of adverse cardiovascular events, including stroke, myocardial infarction, heart failure, and overall mortality.While systematic AF screening using tools such as 12-lead electrocardiography is gaining global attention, cost-effectiveness analyses are highly sensitive to country-specific factors—such as healthcare costs and societal values. Consequently, extrapolating international findings to the Japanese context is often inappropriate, and research utilizing domestic data is strongly warranted to inform local health policy.
METHODS: In this study, we performed a cost-effectiveness analysis of systematic screening for elderly hypertensive patients in Japan. Utilizing evidence from domestic observational studies, including the ANAFIE Registry, Shinken Database, J-RHYTHM Registry, Fushimi-AF Registry, and OMRON Heart Study, we evaluated this strategy through a microsimulation. Unlike standard cohort Markov models, microsimulation estimates costs and utilities using individual attributes like age and disease severity. Specifically, stroke transition probabilities between modified Rankin Scale (mRS) states were adjusted by age and recurrence count for more granular cost-effectiveness estimation. The mRS at recurrence was calculated via conditional probabilities, assuming it would remain unchanged or worsen from the previous onset.
RESULTS: The ICERs of 10,000 microsimulations for men aged 60, 65, and 70 were ¥547,603 ($3,450), ¥876,843 ($5,524), and ¥828,289 ($5,218), respectively. For women of the same ages, the ICERs were ¥750,090 ($4,726), ¥1,013,510 ($6,385), and ¥159,541 ($1,005). At a willingness-to-pay threshold of 5-million-yen ($31,720) per QALY, probabilistic sensitivity analysis (100,000 iterations) accounting for parameter uncertainty showed that the intervention was cost-effective in 81.7%, 85.6%, and 87.8% of simulations for 60-, 65-, and 70-year-old men, respectively, and 78.5%, 79.1%, and 86.4% for 60-, 65-, and 70-year-old women, respectively.
CONCLUSIONS: These results suggest that systematic AF screening is highly cost-effective within the Japanese primary care setting.
METHODS: In this study, we performed a cost-effectiveness analysis of systematic screening for elderly hypertensive patients in Japan. Utilizing evidence from domestic observational studies, including the ANAFIE Registry, Shinken Database, J-RHYTHM Registry, Fushimi-AF Registry, and OMRON Heart Study, we evaluated this strategy through a microsimulation. Unlike standard cohort Markov models, microsimulation estimates costs and utilities using individual attributes like age and disease severity. Specifically, stroke transition probabilities between modified Rankin Scale (mRS) states were adjusted by age and recurrence count for more granular cost-effectiveness estimation. The mRS at recurrence was calculated via conditional probabilities, assuming it would remain unchanged or worsen from the previous onset.
RESULTS: The ICERs of 10,000 microsimulations for men aged 60, 65, and 70 were ¥547,603 ($3,450), ¥876,843 ($5,524), and ¥828,289 ($5,218), respectively. For women of the same ages, the ICERs were ¥750,090 ($4,726), ¥1,013,510 ($6,385), and ¥159,541 ($1,005). At a willingness-to-pay threshold of 5-million-yen ($31,720) per QALY, probabilistic sensitivity analysis (100,000 iterations) accounting for parameter uncertainty showed that the intervention was cost-effective in 81.7%, 85.6%, and 87.8% of simulations for 60-, 65-, and 70-year-old men, respectively, and 78.5%, 79.1%, and 86.4% for 60-, 65-, and 70-year-old women, respectively.
CONCLUSIONS: These results suggest that systematic AF screening is highly cost-effective within the Japanese primary care setting.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE3
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)