OBJECTIVES: There is limited evidence on the clinical and cost benefits of screening for non-valvular atrial fibrillation (NVAF). Predictive algorithms that identify individuals at high risk of NVAF may lead to earlier diagnosis and treatment in eligible patients. A recently published predictive algorithm, UNAFIED-7, was effective in identifying incident AF using Optum’s electronic healthcare record data. We aimed to assess the cost-effectiveness of one-time screening for NVAF utilizing UNAFIED-7 versus usual care in individuals aged 65 from a US payer perspective.

METHODS: A previously published Markov model was adapted to assess the cost-effectiveness of NVAF screening utilizing UNAFIED-7 versus usual care over a lifetime. Screening effectiveness data were sourced from a retrospective algorithm validation study. Clinical risk, utility, and epidemiology inputs were based on published literature, databases and datasets. Cost inputs were sourced from published sources and reported in 2021 US dollars. Costs and quality-adjusted life years (QALYs) were discounted by 3% annually. One-way and probabilistic sensitivity analyses were performed to evaluate uncertainty.

RESULTS: Based on a hypothetical cohort of 10,000 individuals, UNAFIED-7 detected 208 more patients with NVAF (~98% eligible for OAC treatment) compared to usual care resulting in a reduction of ischemic stroke and systemic embolism by 31 and 3 events, respectively. However, increased detection resulted in 76 (MB and CRNMB) additional bleed-related events due to increased anticoagulant use. There was an incremental cost related to screening and anticoagulant use of $6,234,593 however 23% of these costs ($1,449,986) were offset by reduced event-related medical costs, with 97 incremental QALYs. The incremental cost-effectiveness ratio of screening based on UNAFIED-7 was $54,723/QALY. Sensitivity analyses showed consistent results.

CONCLUSIONS: Results suggests that screening for NVAF utilizing the UNAFIED-7 algorithm in individuals aged 65 years for NVAF is a cost-effective strategy from a US payer perspective at a willingness-to-pay threshold of $100,000/QALY.