4.4 Review

Health Economic Research Assessing the Value of Early Detection of Cardiovascular Disease: A Systematic Review

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Refined atrial fibrillation screening and cost-effectiveness in the German population

Renate B. Schnabel et al.

Summary: A study in Germany found that 3.1% of individuals in a population-based health study had atrial fibrillation (AF) detected through a single timepoint electrocardiographic screening, with 0.2% of the sample having new AF. The study showed that cost-effectiveness for screening could be achieved in individuals aged 65 years and older, with the cost per quality-adjusted life-year gained being euro30,361 in the 65-74 year age group.
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Cost-effectiveness of a photopethysmographic procedure for screening for atrial fibrillation in 6 European countries

Steffen Wahler et al.

Summary: This study evaluated the cost-effectiveness of systematic screening using the Preventicus Heartbeats smartphone application. The results showed that this screening method is cost-neutral or even cost-reducing in Western European countries and Greece. However, in countries with low price levels, higher cost increases due to atrial fibrillation screening are expected. The upcoming expiry of patents for direct anticoagulants is expected to lower the cost of anticoagulation and have a positive effect on the cost result.

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Lucca Katrine Sciera et al.

Summary: The study concluded that one-time opportunistic screening for atrial fibrillation in citizens aged >= 65 years in Denmark is cost-effective compared to a willingness-to-pay threshold of euro22 000. The screening program has the potential to identify a significant number of AF patients and prevent strokes, with an incremental cost-effectiveness ratio of euro9400 per QALY gained. The findings support the implementation of opportunistic screening for AF at the general practitioner level in Denmark.

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Summary: A population-based AAA screening program was conducted in Spain, revealing lower than expected prevalence in men and no cases in women. Cost-utility analysis indicated efficiency of the screening program only over a 30-year horizon. This suggests the need to consider alternative strategies for screening in the area.

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Clinical Benefit, Harm, and Cost Effectiveness of Screening Men for Peripheral Artery Disease: A Markov Model Based on the VIVA Trial

Jes S. Lindholt et al.

Summary: Screening for PAD in 65 year old men using a Markov decision model showed reduced amputations and stroke rates, increased rates of revascularisation, acute myocardial infarction, and major bleeding, with overall increased life expectancy. The cost per life year/quality adjusted life year was estimated to be $16,717/$20,673, with the addition of low dose rivaroxaban reducing costs per life year gained by 40%. The model suggested that PAD screening accounted for one fourth of the reported overall 7% relative mortality risk reduction of combined abdominal aortic aneurysm, PAD, and hypertension screening.

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M. S. Jacobs et al.

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Summary: The study evaluated the cost-effectiveness of an artificial intelligence electrocardiogram algorithm for universal screening at age 65, finding it cost-effective in various clinical scenarios but sensitive to test performance, disease characteristics, and testing costs. Further research on disease progression and treatment, as well as external validation of the AI-ECG, is recommended to improve cost-effectiveness modeling.

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Cost-Effectiveness Analysis of Hypertension Screening in the Korea National Health Screening Program

Hae Young Lee et al.

Summary: The study found that including hypertension screening in the national health screening program is cost-effective, especially for adults aged 40 and older. For adults aged 40 and older, the most cost-effective strategy is to conduct a first screening examination with a second confirmatory examination every 3 years.

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Yrjana Hynninen et al.

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