“Undiagnosed atrial fibrillation (AF) is an important cause of stroke. Screening for AF using wrist-worn wearable devices may prevent strokes, but their cost effectiveness is unknown,” write Wanyi Chen, PhD, from Massachusetts General Hospital, Boston, and colleagues, in JAMA Health Forum.
The investigators used a microsimulation decision-analytic model to evaluate the cost-effectiveness of these devices to screen for undiagnosed AF.
The model comprised 30 million simulated individuals with an age, sex, and comorbidity profile matching the US population aged 65 years or older.
The model looked at eight AF screening strategies: six using wrist-worn wearable devices (either watch or band photoplethysmography with or without watch or band electrocardiography), and two using traditional modalities (ie, pulse palpation and 12-lead electrocardiogram), vs no screening.
The primary outcome was the incremental cost-effectiveness ratio, defined as US dollars per quality-adjusted life-year (QALY). Secondary outcomes included rates of stroke and major bleeding.
In the model, the mean age was 72.5 years and 50% were women.
All 6 screening strategies using wrist-worn wearable devices were estimated to be more cost effective than no screening. The model showed that the range of QALYs gained compared with no screening was 226 to 957 per 100,000 individuals.
The wrist-worn devices were also associated with greater relative benefit than screening using traditional modalities, as the range of QALYs gained compared with no screening was -116 to 93 per 100,000 individuals.
Compared with no screening, screening with wrist-worn wearable devices was associated with a reduction in stroke incidence by 20 to 23 per 100,000 person-years but an increase in major bleeding by 20 to 44 per 100,000 person years.
Overall, the preferred strategy for screening was wearable photoplethysmography, followed by wearable electrocardiography with patch monitor confirmation. This strategy had an incremental cost-effectiveness ratio of $57,894 per QALY, “meeting the acceptability threshold of $100,000 per QALY,” the authors write.
The cost-effectiveness of screening was consistent across multiple clinically relevant scenarios, including screening a general population aged 50 years or older with risk factors for stroke, the authors report.
“When deployed within specific AF screening pathways, wearable devices are likely to be an important component of cost-effective AF screening,” the investigators conclude.
Study Based on Modeled Data
“This study is the first simulation of various screening strategies for atrial fibrillation using wearable devices, and suggests that wearable devices, in particular wrist-worn wearables, in an elderly population, is estimated to be cost-effective,” Emma Svennberg, MD, PhD, from the Karolinska University Hospital, Stockholm, Sweden, told theheart.org | Medscape Cardiology.
“I find this study interesting as the adoption of wearables amongst individuals is high and increasing, hence many wearers will screen themselves for arrhythmias (even if healthcare recommendations are discordant), and the potential costs for society have been unknown,” said Svennberg, who was not part of this study.
“Of course, no study is without its flaws, and here one must note that the study is based on modeled data alone, and not RCTs of the wearable screening strategies…hence true clinical outcome data is missing,” Svennberg added.
The large STROKESTOP study, on which she was the lead investigator, “presented data based on true clinical outcomes at ESC 2021 (European Society of Cardiology) and showed cost-effectiveness,” Svennberg said.
The study authors report financial relationships with Bristol Myers Squibb, Fitbit Inc, Medtronic, Pfizer, UpToDate, American Heart Association, IBM, Bayer AG, Novartis, MyoKardia, Boehringer Ingelheim, Heart Rhythm Society, Avania Consulting, Apple, Premier, the National Institutes of Health, Invitae, Blackstone Life Sciences, Flatiron, and Value Analytics Labs. Svennberg reports no relevant financial relationships.
JAMA Health Forum. Published online August 5, 2022. Full text