JMIR Publications

ABSTRACT

Background:

With an estimated prevalence of around 3% and an about 2.5-fold increased risk of stroke, Atrial Fibrillation (AF) is a serious threat for patients and a high economic burden for health care systems all over the world. Patients suffering from AF could benefit from screening through mobile health (mHealth) devices. Thus, an early diagnosis is possible and the risk for stroke can be markedly reduced by using anticoagulation.

Objective:

The aim of this work is to assess the cost-effectiveness of screening for AF with aid of mHealth devices. Even if prevented strokes and prevented deaths from stroke are the most relevant patient outcomes, direct costs were defined as the primary outcome.

Methods:

A Monte Carlo simulation was conducted based on a developed state-transition model. 30,000 patients for each CHA2DS2-VASc score from 1 to 9 were simulated. The first simulation served to estimate the economic burden of AF without the use of mHealth devices. The second, to simulate the economic burden of AF with the use of mHealth devices. Afterwards, the groups were compared in terms of costs, prevented strokes and deaths from strokes.

Results:

The CHA2DS2-VASc score as well as the ECG confirmation rate both had an impact on costs as well as number of strokes. The higher the risk score, the lower were costs per prevented stroke. Higher ECG confirmation rates intensified this effect. The effect was not seen in groups with lower risk scores. The number of prevented strokes tended to be higher in groups with high risk for stroke. Higher ECG confirmation rate led to higher numbers of prevented strokes.

Conclusions:

The use of mHealth devices to screen for AF leads to increasing costs but also to a reduction of stroke. Especially in patients with a higher CHA2DS2-VASc score the risk for stroke and death from stroke can be markedly reduced.