Patch monitor screening for atrial fibrillation may be cost-effective in high-risk patients

Wearing patch monitors for two weeks of atrial fibrillation screening provided economic value in gained quality-adjusted life-years for high-risk older patients, according to a new analysis of a randomized trial.

Using two-week patch monitors to screen for atrial fibrillation in high-risk patients provided high economic value, a new analysis found.

The health economic analysis was based on data from the mHealth Screening to Prevent Strokes (mSToPS) study, which previously found monitoring was linked with lower stroke incidence among at-risk patients. Monitored participants were randomized to receive immediate or delayed monitoring with two patches three months apart. In the current analysis, researchers analyzed three years of claims data from monitored patients and unmonitored controls. Mean patient age was 74 years, and 41% were female. All participants were at high risk for atrial fibrillation. On average, monitored participants wore 1.7 two-week monitors at a mean cost of $614 per patient. Findings were published by Circulation: Cardiovascular Quality and Outcomes on Oct. 31.

Monitored patients had more frequent outpatient visits compared with controls (difference, 190 per 100 patient-years [95% CI, 82 to 298 per 100 patient-years]). However, both ED visits and hospitalizations were less frequent in the intervention group than the control group (−8.3 [95% CI, −12.6 to −4.1] and −15.2 [95% CI, −22 to −8.6] per 100 patient-years, respectively). The total adjusted costs for monitored patients were nonsignificantly higher after three years (mean difference, $1,551 [95% CI, −$1,047 to $4,038]), as were quality-adjusted life-years (QALYs) (8.81 vs. 8.71; difference, 0.09 [95% CI, −0.05 to 0.24]). The slightly higher lifetime costs seen in the monitored group resulted in a cost-effectiveness ratio of $36,100 per QALY gained and $28,600 per life-year gained, the researchers wrote. In addition, the “probability that monitoring would be cost-effective at willingness to pay thresholds of $50,000 and $150,000 per QALY gained was 63.5% and 90.6%, respectively,” they said. The gains in quality-adjusted survival stemmed from a reduction in adverse clinical events over the study period and projected impacts of strokes on life expectancy, they observed.

The study found potentially greater benefit for screening in patients ages 75 years or older compared with younger patients, so the findings may not be generalizable to younger and healthier individuals. “If replicated in future randomized trials, these findings have important implications for payment policy and support continued, confirmatory research in this field,” the authors concluded.

An accompanying editorial pondered the importance of atrial fibrillation detected by opportunistic screening versus clinical indications. “The finding of significant clinical differences in all-cause mortality and in stroke at 3 years favoring the active monitoring group requires us to ask whether the amount of incremental information uniquely provided from active monitoring in this trial could have led to enough alteration of effective therapy (largely initiation of oral anticoagulation) to be the cause of these observed differences,” the editorialists wrote.