OBJECTIVES: Screening for atrial fibrillation (AF) is recommended by the European Society of Cardiology guideline to prevent strokes. Cost-effectiveness analyses of different screening programs for AF are difficult to compare, because of varying settings and models used. We compared the impact and cost-effectiveness of various AF screening programs in the Netherlands.

METHODS: The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the ARISTOTLE, RE-LY and ROCKET AF trial combined with Dutch observational data. Univariate, probabilistic sensitivity and various scenario analyses were performed. The following programmes were evaluated: opportunistic screening patients ≥65-years visiting a GP; opportunistic screening patients ≥65-years visiting a GP for a blood pressure measurement; systematic screening patients ≥75-years visiting a GP; opportunistic screening patients ≥75-years visiting a geriatric outpatient clinic; opportunistic screening patients ≥65-years during influenza vaccination; self-screening using a smartphone.

RESULTS: The maximum number of newly detected AF patients in The Netherlands ranged from 4,554 to 39,270, depending on the screening strategy used. Adequate treatment with anticoagulation would result in a maximum of more than 3000 strokes prevented using single time point AF screening. Compared with no screening, screening 100,000 persons provided a gain in QALYs ranging from 984 to 8,727, and a mean cost difference ranging from -6,650,000€ to 898,000€, depending on the screening strategy used. Probabilistic sensitivity analysis (PSA) demonstrated a 100% likelihood that screening all patients ≥75-years visiting the Geriatric outpatient clinic was cost-saving. Four out of six strategies were cost-saving in ≥74% of the PSA simulations. Out of these, opportunistic screening of all patients ≥65-years visiting the GPs office had the highest impact on strokes prevented.

CONCLUSIONS: Most single-time point AF screening strategies are cost-saving and have an important impact on stroke prevention.