OBJECTIVES: Screening for undiagnosed AF can identify patients who could benefit from anticoagulant therapy and reduce the burden of ischemic stroke (IS) through early intervention. The aim of this study was to evaluate whether population screening for AF in Taiwan could be cost-effective from a government perspective.

METHODS: Our study was based on an AF population screening study that enrolled 23,572 Taiwanese adults tested by a single-lead electrocardiogram. A Markov decision-analysis model was constructed to simulate the lifelong outcomes and costs of a hypothetical cohort of 10,000 65-year-old individuals with and without one-off screening for AF. Clinical events considered included IS, intracranial hemorrhage, and death. Direct costs were estimated from a government perspective, and future costs and benefits were discounted at an annual rate of 3%. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty. Threshold analyses were used to determine the optimal age for implementing screening.

RESULTS: In a hypothetical cohort of 10,000 individuals aged 65 years, one-off population screening for AF compared with no screening could detect 49 undiagnosed AF cases, increasing 26.19 quality-adjusted life years (QALYs) and preventing 22 ischemic strokes in the remaining lifetime with additional costs of 309,337 USD. The incremental cost-effectiveness ratio of screening versus no screening was USD 11,810 per QALY gained. The results were robust in all sensitivity analyses. One-way sensitivity analyses showed that the ICERs were most sensitive to the effectiveness of anticoagulants in IS prevention and the incidence of IS. In the probabilistic sensitivity analysis, 99.92% of iterations produced ICERs below the willingness-to-pay threshold of one GDP per QALY. Screening at the age of 80 resulted in the lowest cost per QALY gained (USD 10,144/QALY).

CONCLUSIONS: Screening for AF to detect undiagnosed AF in the elderly population can be a cost-effective intervention for stroke prevention in Taiwan.