Screening for Atrial Fibrillation in Sub-Saharan Africa: A Health Economic Evaluation to Assess the Feasibility in Nigeria.

M S Jacobs,R G Tieleman,M Van Hulst,A M Adeoye,M J Postma,M O Owolabi

doi:10.5334/gh.893

Abstract

Background:Cardiovascular disease reflects a major burden of non-communicable disease in Sub-Saharan Africa (SSA). Early detection and treatment of atrial fibrillation (AF), as a preventive measure against stroke, is currently not in the scope of the World Health Organization recommendation to reduce cardiovascular disease.Objective:We hypothesized that screening for AF would be an important approach to determine the true AF prevalence in the general population in African countries and to identify asymptomatic AF patients at risk for stroke to optimize prevention.Methods:A decision analytic model was developed to study the health-economic impact of AF screening in Nigeria over a life-time horizon. The patient population explored in the model was a population of newly detected AF cases that would be diagnosed with a one-time systematic screening for AF with a single lead ECG device in community health centres across Nigeria.Conclusions:The health gain per newly detected AF patient (N = 31,687) was 0.41 QALY at a cost of $5,205 per patient with 100% NOAC use, leading to an ICER of $12,587 per QALY gained. The intervention was cost-effective with a 99.9% warfarin use with an ICER of $1,363 per QALY gained. The total cost of a single screening session was $7.3 million for the total screened population in Nigeria or $1.60 per patient screened. Screening for AF to detect AF patients in need for stroke prevention can be a cost-effective intervention in the Sub-Saharan region, depending on type of anticoagulant used and drug costs.

Highlights

Non-communicable diseases are an increasing health burden in Sub-Saharan Africa (SSA) [1,2,3,4]
Taking into account the screening attendance rate of 50%, there were 31,687 new atrial fibrillation (AF) patients detected with a single screening session
The screening scenario was associated with higher costs and higher QALYs, the cost of treatment was 94% of the total costs in the scenario where all patients would be treated with a NOAC

Summary

Introduction

Non-communicable diseases are an increasing health burden in Sub-Saharan Africa (SSA) [1,2,3,4]. Detection and treatment of atrial fibrillation (AF), is not part of the total risk approach that the World Health Organization recommends to prevent cardiovascular disease [7]. We hypothesized that screening for AF would be an important approach to determine the true AF prevalence in the general population in African countries and to identify asymptomatic AF patients at risk for stroke to optimize prevention. Detection and treatment of atrial fibrillation (AF), as a preventive measure against stroke, is currently not in the scope of the World Health Organization recommendation to reduce cardiovascular disease. Objective: We hypothesized that screening for AF would be an important approach to determine the true AF prevalence in the general population in African countries and to identify asymptomatic AF patients at risk for stroke to optimize prevention. Screening for AF to detect AF patients in need for stroke prevention can be a cost-effective intervention in the Sub-Saharan region, depending on type of anticoagulant used and drug costs

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Discussion

Conclusion