Abstract / Summary
Although the guidelines recommend opportunistic screening for adults ≥ 65 years, screening for atrial fibrillation (AF) remains underutilised in Australia. The absence of guidance on how often to screen has resulted in variable practice and missed opportunities for AF detection. Previous studies have focused on handheld devices rather than 12-lead electrocardiogram (ECG) devices that are readily available in primary-care settings, and the evidence supporting an annual AF screening programme in Australia is limited. Therefore, the aim of this study is to compare the cost-effectiveness of an annual, structured, higher‑coverage opportunistic ECG screening approach (annual screening) with current unstructured opportunistic screening (current screening) in older adults in Australia. A Markov model was developed to evaluate two strategies for adults ≥ 65 years: (1) annual screening using 12-lead ECG and (2) current opportunistic screening. The model included 11 health states capturing AF treatment and outcomes, and simulations were run using monthly cycles. A health system perspective and 10-year time horizon were applied. To account for uncertainty, a probabilistic sensitivity analysis with 1000 iterations was undertaken and the results were assessed against a cost-effectiveness threshold of 28,000 Australian dollars (AU$) per quality-adjusted life year (QALY). Uncertainty was further examined through cost-effectiveness acceptability curves and scenario analyses to test the stability of findings under alternative assumptions. Annual screening increased costs by AU$4213 and gained 0.43 QALYs, yielding an incremental cost-effectiveness ratio of AU$9797 per QALY gained. Probabilistic sensitivity analysis demonstrated that 100% of simulations yielded a positive incremental net monetary benefit. Scenario analyses demonstrated that both higher screening costs and less frequent 3-yearly screening were cost-effective in comparison to the current opportunistic screening, with incremental cost-effectiveness ratios below the cost-effectiveness threshold and positive incremental net monetary benefits in all scenarios. A structured annual screening approach for AF is likely to be a cost-effective strategy within the Australian primary-care setting. These findings highlight the benefits of more consistent screening practices for early AF detection and stroke prevention.