Atrial Fibrillation Screening Using Wearable Devices May be Cost-Effective

Jagpreet Chhatwal, PhD

Screening for atrial fibrillation (AF) using wearable devices is cost-effective when compared to either no screening or AF screening using traditional methods, according to new findings.

The cost-effectiveness carried across multiple clinically relevant scenarios, which included screening a general population aged 50 years or older with risk factors for stroke as well as those at younger ages than currently endorsed by guidelines.

“In general, our findings support previous observations suggesting that AF screening can be cost-effective, and they provide new evidence that strategies using wearable devices may be economically favorable,” wrote study author Jagpreet Chhatwal, PhD, Institute for Technology Assessment, Massachusetts General Hospital.

Although screening for AF using wrist-worn wearable devices is now possible, it may require repeated screening with greater sampling density and longer durations to detect less-frequent episodes. This may result in increased costs and harms associated with downstream testing and false positives.

The current study compared the cost-effectiveness of 8 AF screening strategies with no screening. Of these strategies, 6 used wrist-worn wearable devices (watch or band photoplethysmography, with or without watch or band electrocardiography) and 2 using traditional modalities (pulse palpation and 12-lead electrocardiogram) versus no screening.

The economic evaluation used a microsimulation decision-analytic model and was performed from September 2020 - May 2022. The mode simulated a 30 million-person cohort matched on age and comorbidity distribution with the 2019 US population aged ≥65 years old, the age at which AF screening is recommended.

For each simulated strategy, investigators calculated total quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs) were calculated. The secondary measures included rates of stroke and major bleeding.

In the base case analysis, the mean age was reported as 72.5 years and 50% of included individuals were women.

The findings suggest all 6 screening strategies using wrist-worn wearable devices were estimated to be more effective when compared to no screening (range of QALYs gained, 226 - 957 per 100,000 individuals). They were additionally associated with greater relative benefit compared to screening using traditional modalities (range of QALYs gained, -116 to 93 per 100,000 individuals)

Moreover, screen using wrist-worn wearable devices was associated with a reduction in stroke incidence by 20 to 23 per 100,000 person-years. However, it was associated with an increase in major bleeding by 20 to 44 per 100,000 person-years.

The data show the overall cost-effective strategies to be wrist-worn photoplethysmography followed by wearable electrocardiography with patch monitor confirmation. This had an incremental cost-effectiveness ratio of $57,894 per QALY, meeting the acceptability threshold of $100,000 per QALY.

“Wearable screening remained cost-effective across strata of sex and substantial variations in wearable device–related costs and mean daily wear time,” Chhatwal added.

The study, “Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices,” was published in JAMA Health Forum.