COST-EFFECTIVENESS OF PRECISION SCREENING FOR ATRIAL FIBRILLATION: A DECISION-ANALYTIC MODEL
Author(s)
Daniel Kim, PhD, Steven J Atlas, MD, Daniel Singer, MD, Steven Lubitz, MD, MPH, Patrick Ellinor, MD, PhD, Jag Chhatwal, PhD, Shaan Khurshid, MD, MPH.
Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA.
Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA.
OBJECTIVES: Atrial fibrillation (AF) is common, frequently unrecognized, and a major cause of preventable stroke. Recent studies suggest that screening guided by estimated AF risk (e.g., clinical scores or artificial intelligence [AI]-based methods) may be more efficient than age-based screening, but cost-effectiveness remains uncertain. We evaluated the cost-effectiveness of AF screening based on age versus estimated risk.
METHODS: We developed an individual-level multistate model to simulate 30 million U.S. adults aged ≥50 years with nationally representative age and comorbidity distributions. Analyses were restricted to individuals with a guideline-based indication for anticoagulation based on the CHA₂DS₂-VASc stroke risk score. We compared no-screening with two screening modalities: 1) traditional (pulse palpation followed by 12-lead ECG), and 2) contemporary (wrist-worn wearable monitoring). Within each modality, we compared three approaches to selecting AF screening candidates: (a) age-guided (≥65 years), (b) risk-guided (5-year AF risk≥5%), or (c) combined. AF risk was estimated using the validated CHARGE-AF risk score (traditional) or an ECG-based AI risk model with comparable discrimination (contemporary). We projected lifetime costs and quality-adjusted life-years (QALYs, tabulated per 1,000 individuals), discounted at 3% annually, and estimated incremental cost-effectiveness ratios (ICERs).
RESULTS: In incremental cost-effectiveness analyses, only contemporary risk-guided and contemporary combined screening remained on the efficiency frontier. Contemporary risk-guided screening resulted in incremental benefit vs no-screening (incremental QALYs 107 per 1,000 at $24,931/QALY), while contemporary combined screening was the overall most cost-effective strategy (incremental QALYs 10.4 per 1,000 at $37,407/QALY vs contemporary risk-guided screening). Among traditional modalities only, risk-guided screening was the most cost-effective strategy (ICER $30,642/QALY vs no-screening). Contemporary modalities generally achieved greater health benefits (incremental QALY range 107-117 per 1,000 vs no-screening) versus traditional modalities (25-43).
CONCLUSIONS: Precision AF screening incorporating individual estimated AF risk offers favorable cost-effectiveness versus current guideline-based strategies using age alone. Prospective evaluation and implementation of risk-guided AF screening programs are warranted.
METHODS: We developed an individual-level multistate model to simulate 30 million U.S. adults aged ≥50 years with nationally representative age and comorbidity distributions. Analyses were restricted to individuals with a guideline-based indication for anticoagulation based on the CHA₂DS₂-VASc stroke risk score. We compared no-screening with two screening modalities: 1) traditional (pulse palpation followed by 12-lead ECG), and 2) contemporary (wrist-worn wearable monitoring). Within each modality, we compared three approaches to selecting AF screening candidates: (a) age-guided (≥65 years), (b) risk-guided (5-year AF risk≥5%), or (c) combined. AF risk was estimated using the validated CHARGE-AF risk score (traditional) or an ECG-based AI risk model with comparable discrimination (contemporary). We projected lifetime costs and quality-adjusted life-years (QALYs, tabulated per 1,000 individuals), discounted at 3% annually, and estimated incremental cost-effectiveness ratios (ICERs).
RESULTS: In incremental cost-effectiveness analyses, only contemporary risk-guided and contemporary combined screening remained on the efficiency frontier. Contemporary risk-guided screening resulted in incremental benefit vs no-screening (incremental QALYs 107 per 1,000 at $24,931/QALY), while contemporary combined screening was the overall most cost-effective strategy (incremental QALYs 10.4 per 1,000 at $37,407/QALY vs contemporary risk-guided screening). Among traditional modalities only, risk-guided screening was the most cost-effective strategy (ICER $30,642/QALY vs no-screening). Contemporary modalities generally achieved greater health benefits (incremental QALY range 107-117 per 1,000 vs no-screening) versus traditional modalities (25-43).
CONCLUSIONS: Precision AF screening incorporating individual estimated AF risk offers favorable cost-effectiveness versus current guideline-based strategies using age alone. Prospective evaluation and implementation of risk-guided AF screening programs are warranted.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE214
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)