Compared with traditional methods, screening for atrial fibrillation (AF) with wearable devices, like those worn on the wrist, was easy and cost-effective, a recent US study has found.
“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,” said Wanyi Chen, PhD, from Massachusetts General Hospital, Boston, and colleagues, whose study was published in JAMA Health Forum.
The investigators used a microsimulation decision-analytic model to evaluate the cost-effectiveness of these devices to screen for undiagnosed AF, reports Medscape.
The model comprised 30m simulated individuals with an age, sex and comorbidity profile matching the US population aged 65 years or older.
The model looked at eight AF screening strategies: six using wrist-worn wearable devices (either watch or band photoplethysmography with or without watch or band electrocardiography), and two using traditional modalities (i.e., pulse palpation and 12-lead electrocardiogram), versus no screening.
The primary outcome was the incremental cost-effectiveness ratio, defined as US dollars per quality-adjusted life-year (QALY). Secondary outcomes included rates of stroke and major bleeding.
In the model, the mean age was 72.5 years and 50% were women.
All six screening strategies using wrist-worn devices were estimated to be more cost-effective than no screening. The model showed that the range of QALYs gained compared with no screening was 226 to 957 per 100 000 individuals.
The wrist-worn devices were also associated with greater relative benefit than screening using traditional modalities, as the range of QALYs gained compared with no screening was –116 to 93 per 100 000 individuals.
Compared with no screening, screening with wrist-worn devices was associated with a reduction in stroke incidence by 20 to 23 per 100 000 person-years but an increase in major bleeding by 20 to 44 per 100 000 person years.
Overall, the preferred strategy for screening was wearable photoplethysmography, followed by wearable electrocardiography with patch monitor confirmation. This strategy had an incremental cost-effectiveness ratio of $57 894 per QALY, “meeting the acceptability threshold of $100 000 per QALY”, the authors said.
The cost-effectiveness of screening was consistent across multiple clinically relevant scenarios, including screening a general population aged 50 or older with risk factors for stroke, the authors report.
“This study is the first simulation of various screening strategies for atrial fibrillation using wearable devices, and suggests that wearable devices, in particular wrist-worn wearables, in an elderly population, is estimated to be cost-effective,” said Dr Emma Svennberg, PhD, from the Karolinska University Hospital, Stockholm, Sweden, who was not part of the study.
“This study was interesting as the wearing of these devices is popular and increasing, so many people will screen themselves for arrhythmias (even if healthcare recommendations are discordant), and the potential costs for society have been unknown.
“No study is without its flaws, and here one must note that the study is based on modelled data alone, and not RCTs of the wearable screening strategies…hence true clinical outcome data are missing,” she added.
Study details
Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices
Wanyi Chen, Shaan Khurshid, Daniel E. Singer, et al
Published in JAMA Health Forum on 5 August 2022
Key Points
Question Is population-based atrial fibrillation (AF) screening using wearable devices cost-effective?
Findings In this economic evaluation of 30m simulated individuals with an age, sex, and comorbidity profile matching the US population aged 65 years or older, AF screening using wearable devices was cost-effective, with the overall preferred strategy identified as wearable photoplethysmography, followed conditionally by wearable electrocardiography with patch monitor confirmation (incremental cost-effectiveness ratio, $57 894 per quality-adjusted life-year). The cost-effectiveness of screening was consistent across multiple scenarios, including strata of sex, screening at earlier ages, and with variation in the association of anticoagulation with risk of stroke associated with screening-detected AF.
Meaning This study suggests that contemporary AF screening using wearable devices may be cost-effective.
Abstract
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 30m 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 screening using traditional modalities (range of QALYs gained vs no screening, −116 to 93 per 100,000 individuals). Compared with no screening, screening using wrist-worn wearable devices was associated with a reduction in stroke incidence by 20 to 23 per 100,000 person-years but an increase in major bleeding by 20 to 44 per 100,000 person-years. The overall preferred strategy was wearable photoplethysmography, followed conditionally by wearable electrocardiography with patch monitor confirmation, which had an incremental cost-effectiveness ratio of $57,894 per QALY, meeting the acceptability threshold of $100,000 per QALY. The cost-effectiveness of screening was consistent across multiple scenarios, including strata of sex, screening at earlier ages (eg, ≥50 years), and with variation in the association of anticoagulation with risk of stroke in the setting of screening-detected AF.
Conclusions and Relevance
This economic evaluation of AF screening using a microsimulation decision-analytic model suggests that screening using wearable devices is cost-effective compared with either no screening or AF screening using traditional methods.
Medscape article – Using Wearable Devices to Detect AF Is ‘Cost Effective’ (Open access)
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