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Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
Danderyd Hospital, Sweden.
Danderyd Hospital, Sweden.
Halland Hospital, Sweden.
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2015 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 7, 1023-1029 p.Article in journal (Refereed) Published
Abstract [en]

Aims The aim of this study was to estimate the cost-effectiveness of 2 weeks of intermittent screening for asymptomatic atrial fibrillation (AF) in 75/76-year-old individuals. Methods and results The cost-effectiveness analysis of screening in 75-year-old individuals was based on a lifelong decision analytic Markov model. In this model, 1000 hypothetical individuals, who matched the population of the STROKESTOP study, were simulated. The population was analysed for different parameters such as prevalence, AF status, treatment with oral anticoagulation, stroke risk, utility, and costs. In the base-case scenario, screening of 1000 individuals resulted in 263 fewer patient-years with undetected AF. This implies eight fewer strokes, 11 more life-years, and 12 more quality-adjusted life years (QALYs) per 1000 screened individuals. The screening implies an incremental cost of (sic)50 012, resulting in a cost of (sic)4313 per gained QALY and (sic)6583 per avoided stroke. Conclusions With the use of a decision analytic simulation model, it has been shown that screening for asymptomatic AF in 75/76-year-old individuals is cost-effective.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY , 2015. Vol. 17, no 7, 1023-1029 p.
Keyword [en]
Atrial fibrillation; Screening; Hand-held ECG; Quality-adjusted life year ( QALY); Cost-effectiveness
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-120879DOI: 10.1093/europace/euv083ISI: 000359153000006PubMedID: 25868469OAI: oai:DiVA.org:liu-120879DiVA: diva2:849388
Note

Funding Agencies|Swedish Heart and Lung Foundation; Board of Benevolence of the Swedish Order of Freemasons; Tornspiran

Available from: 2015-08-28 Created: 2015-08-28 Last updated: 2017-09-29
In thesis
1. Health Economic Evaluations of Screening Programs - Applications and Method Improvements
Open this publication in new window or tab >>Health Economic Evaluations of Screening Programs - Applications and Method Improvements
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening.

The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making.

This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations.

As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design.

In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 84 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1578
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-141556 (URN)10.3384/diss.diva-141556 (DOI)9789176854914 (ISBN)
Public defence
2017-10-06, Belladonna, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2017-09-29Bibliographically approved

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