Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices

作者：Wanyi Chen, Shaan Khurshid, Daniel E. Singer, Steven J. Atlas, Jeffrey M. Ashburner, Patrick T. Ellinor, David D. McManus, Steven A. Lubitz, Jagpreet Chhatwal · 发表于：JAMA Health Forum · 年份：2022 · DOI：10.1001/jamahealthforum.2022.2419 · 被引用次数：60 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiovascular Disease and Adiposity、Acute Ischemic Stroke Management

Importance: Undiagnosed atrial fibrillation (AF) is an important cause of stroke. Screening for AF using wrist-worn wearable devices may prevent strokes, but their cost-effectiveness is unknown. Objective: To evaluate the cost-effectiveness of contemporary AF screening strategies, particularly wrist-worn wearable devices. Design Setting and Participants: This economic evaluation used a microsimulation decision-analytic model and was conducted from September 8, 2020, to May 23, 2022, comprising 30 million simulated individuals with an age, sex, and comorbidity profile matching the US population aged 65 years or older. Interventions: Eight AF screening strategies, with 6 using wrist-worn wearable devices (watch or band photoplethysmography, with or without watch or band electrocardiography) and 2 using traditional modalities (ie, pulse palpation and 12-lead electrocardiogram) vs no screening. Main Outcomes and Measures: The primary outcome was the incremental cost-effectiveness ratio, defined as US dollars per quality-adjusted life-year (QALY). Secondary measures included rates of stroke and major bleeding. Results: In the base case analysis of this model, the mean (SD) age was 72.5 (7.5) years, and 50% of the individuals were women. All 6 screening strategies using wrist-worn wearable devices were estimated to be more effective than no screening (range of QALYs gained vs no screening, 226-957 per 100 000 individuals) and were associated with greater relative benefit than scree...