Edinburgh Napier University

  Purpose: Identifying unknown atrial fibrillation (AF) in the community and subsequent anti-thrombotic treatment could reduce stroke burden. We aimed to determine the cost-effectiveness of community screening for unknown AF, using an iPhone ECG with an automated algorithm (iECG) in pharmacies.

Methods: Cost-effectiveness analysis from an Australian health funder perspective comparing cost of iECG population-based AF screening, to diagnosed AF in an unscreened population, for age 65-84. Results are expressed as incremental cost-effectiveness ratio (ICER) per stroke avoided and per quality adjusted life year (QALY) gained. The model assumed a rate of unknown AF of 1.4% in target population; test sensitivity 97%; test specificity 92%; cost of warfarin treatment and monitoring $AUD803.80 (€421.73) pa; cost per screen $AUD20 (€10.49); and 5.09 QALYs gained per stroke avoided. Benefits of detecting AF are based on data obtained from the UK Clinical Practice Research Datalink using a subset of 5,567 patients with incidentally detected asymptomatic AF, with incidence rates projected out to 10 years following initial screen. Sensitivity analyses varied base assumptions for anticoagulant guideline-adherence rate.

Results: The ICER of extending iECG screening into the community, based on 55% warfarin prescription adherence, would be $AUD5,951 (€3,122) per QALY gained and $AUD30,290 (€15,892) for prevention of one stroke. Sensitivity analysis indicated cost-effectiveness improved with increased treatment adherence.

Conclusions: Screening with iECG in pharmacies is cost effective for stroke prevention and gaining QALY, and well within a range fundable on a population basis, using either warfarin or novel oral anticoagulants. Guideline recommendation of community iECG screening for AF should be considered.