Cost-effectiveness of a community-based screening programme for chronic atrial fibrillation in Japan

Objectives: To examine the cost-effectiveness of a community-based screening programme for chronic atrial fibrillation (AF) in Japan. Methods: Using a computer model of a Markov process, the cost-effectiveness of an annual ECG screening programme and an annual pulse palpation screening programme for arrhythmia were compared with no screening. A hypothetical Japanese population of 65 year old individuals was followed until 85 years of age. We assumed that individuals with irregular beats on palpation were worked up by ECG and that ECG was perfect in detecting AF, whereas palpation was not. It was also assumed that patients diagnosed with AF received anticoagulant therapy, that some AF patients developed ischaemic stroke, and that some on anticoagulant therapy developed intracranial or gastrointestinal haemorrhage. Costs, efficacy of anticoagulation, utility of health status, and clinical variables were estimated from the literature. Outcomes were expressed as US dollars per quality-adjusted life-year (QALY). Results: Both annual ECG screening programme and annual palpation screening programme were more costly and at the same time more effective compared with no screening, with their incremental cost-effectiveness ratios approximately US$8000 per QALY in males and US$10,000 per QALY in females. Sensitivity analyses showed high sensitivity of cost-effectiveness ratios to the incidence of ischaemic stroke and anticoagulants prescription rate. Two annual screening programmes were similar in effectiveness and costs. Conclusion: To prevent ischaemic stroke associated with AF, both annual ECG screening and annual palpation screening were favourable in the context of conventional criteria for cost-effectiveness.