Economic Evaluation of Diagnostic Strategies for Atrial Fibrillation: A Markov model for the Netherlands

The health care market is characterised by many market imperfections. Cost-effectiveness analyses aim to replicate consumption decisions to optimally allocate resources. This paper compares the cost effectiveness of the current diagnostic strategy for atrial fibrillation (AF) to diagnostic strategies based on the relatively new Stroke Risk Analysis (SRA), from a health care sector perspective. The costeffectiveness analysis is conducted by a Markov model, a mathematical simulation model to calculate the costs and health effects in terms of quality-adjusted life years (QALYs) of each diagnostic strategy for a targeted population aged 65 and older with AF symptoms. The comparative analyses result in incremental costs and incremental QALYs of the SRA strategies compared to care as usual. AF patients have an increased risk of stroke that can be mitigated with treatment once they are diagnosed. The simulation model demonstrates that the SRA strategies increase AF diagnoses but do not increase the quality-adjusted life years of the target population, compared to care as usual. The health benefits of avoided strokes in newly diagnosed AF patients are outweighed by the negative health effects due to treatment complications in newly, correctly and incorrectly, diagnosed individuals