Simulation model: Wearable devices cost-effective for AF screening
In a microsimulation decision-analytic model, wrist-worn devices were cost-effective at screening for atrial fibrillation compared with traditional modalities or no screening.
“The proliferation of wrist-worn devices for AF detection provides a convenient option for population-wide screening, though it’s not known if their use will lead to increased costs and problems related to follow-up testing and false positives,” Jagpreet Chhatwal, PhD, director of the Massachusetts General Hospital Institute for Technology Assessment and assistant professor of radiology at Harvard Medical School, said in a press release. “We therefore simulated a virtual trial comparing clinical and cost outcomes under different AF screening strategies, and showed that those using wrist-worn devices generally resulted in greater benefits compared to traditional modalities, and at a cost deemed affordable to the health care system.”
The researchers conducted an economic evaluation from Sept. 8, 2020, to May 23, 2022, using a microsimulation decision-analytic model of 30 million simulated individuals with age, sex and comorbidity profiles matching the general U.S. population aged 65 years or older (mean age, 73 years; 50% women).
The evaluation compared six wrist-worn wearable AF screening strategies — watch or band photoplethysmography, with or without watch or band electrocardiography — and two traditional AF screening strategies (pulse palpitation and 12-lead ECG) with no screening.
The primary outcome was incremental cost-effectiveness ratio, defined as U.S. dollars per quality-adjusted life-year.
Compared with no screening, all six wrist-worn wearable AF screening strategies were more effective than no screening (range of QALYs gained, 226 per 100,000 people to 957 per 100,000 people), the researchers wrote.
The wearable AF screening strategies were also associated with greater relative benefit compared with the traditional methods (range of QALYs gained from traditional methods vs. no screening, –116 per 100,000 people to 93 per 100,000 people).
AF screening using wrist-worn wearable devices was associated with a reduction in incident stroke compared with no screening (range, 20 per 100,000 person-years to 23 per 100,000 person-years) but a rise in major bleeding (range, 20 per 100,000 person-years to 44 per 100,000 person-years), the researchers wrote.
Wearable photoplethysmography, followed conditionally by wearable electrocardiography with patch monitor confirmation, was the most cost-effective AF screening strategy, with an incremental cost-effectiveness ratio of $57,894 per QALY, under the acceptability threshold of $100,000 per QALY, according to the researchers.
The results did not change according to sex, when the minimum age was 50 years instead of 65 years and with variation in the association of anticoagulation with risk for stroke in the setting of screening-detected AF, the researchers wrote.
“We believe our findings provide justification for integrating wrist-worn wearables into AF screening programs, and potentially targeting populations younger than the typically recommended age of 65 for AF screening, perhaps even as low as age 50,” Shaan Khurshid, MD, MPH, an electrophysiology fellow at Massachusetts General Hospital, said in the release. “Moreover, the ability to use these monitoring devices over extended periods could lead to the detection of infrequent paroxysmal AF, which is otherwise very difficult for clinicians to diagnose.”
Reference:
Massachusetts General Hospital. www.eurekalert.org/news-releases/960847. Published Aug. 5, 2022. Accessed Aug. 11, 2022.
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