Abstract 13850: Cost-Effectiveness Analysis of Universal Screening for Atrial Fibrillation Using Electrocardiographic Artificial Intelligence in a Rural Community in Taiwan

Abstract

Introduction: Atrial fibrillation (AF) substantially contributes to strokes, and screening for AF is generally recommended. However, implementing universal screening for AF is challenging in rural areas with limited medical resources. This study assessed the cost-effectiveness of using artificial intelligence-enabled 12-lead electrocardiography (AI-ECG) for AF screening in a rural community. Methods: The cost-effectiveness analysis focused on screening individuals aged 65 or older and utilized a lifelong decision analytic Markov model. The AI-ECG for AF was trained at a medical center in Taiwan, achieving a sensitivity of 0.944 (standard error [SE]: 0.015) and specificity of 0.941 (SE: 0.008). Costs and efficacy of anticoagulant treatments, utility of health status, and clinical variables such as stroke and major bleeding risks were estimated based on literature and epidemiological data from Taiwan. Results were presented as US dollars per quality-adjusted life year (QALY). The base-case analysis compared technicians using AI-ECG for AF detection and referral, and physicians' evaluation with standard 12-lead ECGs to no screening. Uncertainty in the model was addressed through probabilistic sensitivity analysis. Results: Both AI-ECG screening and screening by a physician were found to be more costly yet more effective when compared to no screening. While both strategies exhibited similar effectiveness, the cost was lower with AI-ECG than by a physician ($453 versus $490). Based on 10,000 Monte Carlo simulations, if the willingness to pay (WTP) for a QALY exceeds $9,514, screening by a physician is a cost-effective strategy. However, if the WTP per QALY falls between $2,289 and $9,514, AI-ECG screening is more cost-effective than physician-based screening. Conclusion: This economic evaluation demonstrates the cost-effectiveness of AI-ECG screening for AF, making it a practical alternative for AF screening in areas with limited medical resources.