Cost-effectiveness of three screening strategies for atrial fibrillation in Sri Lanka: a decision-tree modelling analysis using community-based prevalence data.

Systematic screening detected the most new AF cases but at the highest cost among the three strategies.

• Systematic screening detected 48 new AF cases among 10,000 screened individuals.
• Total cost of systematic screening was Rs 698,422 (US$2,123) for 10,000 screened individuals.
• This was the most expensive of the three strategies evaluated.

Targeted screening detected nearly as many AF cases as systematic screening at a lower cost.

• Targeted screening detected 47 new AF cases among 7,780 screened individuals.
• Total cost of targeted screening was Rs 492,002 (US$1,496).
• Targeted screening covered fewer individuals (7,780) than systematic screening (10,000) but detected only one fewer AF case.

Opportunistic screening was the cheapest strategy but identified the fewest new AF cases.

• Opportunistic screening cost Rs 360,617 (US$1,096) and screened 6,556 individuals.
• Only 30 new AF cases were identified through opportunistic screening.
• This represents 18 fewer cases detected compared to systematic screening and 17 fewer than targeted screening.

The ICER of targeted screening compared with opportunistic screening was lower than that of systematic screening compared with opportunistic screening.

• The ICER of targeted versus opportunistic screening was Rs 7,729 (US$23) per additional detected AF case.
• The ICER of systematic versus opportunistic screening was Rs 18,767 (US$57) per additional detected AF case.
• These ICERs represent the incremental total aggregated cost divided by the incremental number of new detected AF cases.

Systematic screening compared with targeted screening yielded a very high cost per additional AF case detected.

• When systematic screening was compared directly with targeted screening, the cost per additional detected AF case was Rs 206,420 (US$628).
• This high ICER reflects that systematic screening detected only one additional AF case (48 vs 47) at substantially higher cost (Rs 698,422 vs Rs 492,002).
• This finding drove the conclusion that systematic screening was not cost-effective relative to targeted screening.

The study used a decision-tree model based on prevalence data from a community-based cross-sectional study of 10,000 individuals in Northern Province, Sri Lanka.

• The study population comprised individuals aged ≥50 years screened using AliveCor, a handheld single-lead ECG device.
• The analysis adopted a Sri Lankan public health system perspective with a 1-year time horizon.
• Three screening strategies were compared: systematic, opportunistic, and targeted.
• The ICER was defined as the incremental total aggregated cost between screening strategies divided by the incremental number of new detected AF cases.

Targeted screening with AliveCor was identified as the most cost-effective strategy for AF detection in Sri Lanka.

• Targeted screening achieved near-equivalent AF case detection to systematic screening (47 vs 48 cases) at lower cost.
• The findings support integrating targeted screening into Sri Lanka's primary care pathways.
• Systematic screening, while having similar effectiveness to targeted screening, was deemed not cost-effective due to high additional costs to detect just one further case.