A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke

Europace. 2015 Feb;17(2):207-14. doi: 10.1093/europace/euu213. Epub 2014 Oct 27.


Aims: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.

Methods and results: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.

Conclusion: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.

Keywords: Atrial fibrillation; Cost-effectiveness; Ischaemic stroke; QALY; Screening; Secondary prevention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Asymptomatic Diseases
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / economics
  • Brain Ischemia / diagnosis*
  • Brain Ischemia / etiology
  • Cost-Benefit Analysis
  • Electrocardiography / economics
  • Electrocardiography, Ambulatory / economics*
  • Humans
  • Markov Chains
  • Mass Screening / economics*
  • Quality-Adjusted Life Years*
  • Secondary Prevention / economics
  • Stroke / diagnosis*
  • Stroke / economics
  • Stroke / etiology
  • Sweden