Health Economic Analysis Research Articles

P2 The Value of Vaccination: Capturing the Impact of Vaccination on Health Equity in Health Economic Analysis

P2 The Value of Vaccination: Capturing the Impact of Vaccination on Health Equity in Health Economic Analysis

Progressive resistance training in young people with Prader-Willi syndrome: protocol for a randomised trial (PRESTO)

IntroductionPreliminary evidence suggests that progressive resistance training may be beneficial for people with Prader-Willi Syndrome (PWS), a rare genetic condition that results in muscle weakness and low muscle tone.To establish...

Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol

IntroductionCardiovascular disease (CVD) is the leading cause of death in women around the world. Aboriginal and Torres Strait Islander women (Australian Indigenous women) have a high burden of CVD, occurring...

Screening for familial hypercholesterolaemia in primary school children: protocol for a cross-sectional, feasibility study in Luxembourg city (EARLIE)

IntroductionFamilial hypercholesterolaemia (FH) is a frequent (1:300) autosomal dominantly inherited condition which causes premature (women <60 years, men <55 years) cardio–cerebrovascular disease (CVD). Early detection and initiation of treatment can...

OP79 Incorporating Environmental Impacts Into Health Technology Assessment: An Examination Of Potential Approaches And Challenges

IntroductionIn light of government and healthcare system commitments to reducing the carbon footprint of healthcare, health technology assessment (HTA) agencies are increasingly motivated to investigate how to consider environmental sustainability in their assessments and guidance. This constitutes a major departure from the existing remits and objectives of most agencies, which typically focus on improving population health outcomes. This presentation seeks to identify options for incorporating environmental impact data into HTA and to examine the main challenges, focusing on the National Institute for Health and Care Excellence (NICE) as a case study.MethodsWe present four broad approaches that could be pursued, informed by policy analysis undertaken by NICE. The strengths, weaknesses and implications of each approach are assessed.ResultsThe first option is to act as an ‘information conduit’, aggregating and distributing in a standardized format environmental impact information that is provided voluntarily by health technology manufacturers. The second is to present complementary analyses of environmental impact data, separately but alongside results from established health economic analyses (‘parallel evaluation’ model). The third is to incorporate environmental impact data into health economic analyses, for example by monetizing environmental outcomes, so that quantitative estimates of treatment value are directly affected by environmental benefits and costs (‘integrated evaluation’ model). The fourth is to create new decision-making frameworks for evaluating healthcare interventions that are not expected to improve health-related outcomes, but claim to have relative environmental benefits.ConclusionsWe conclude that these approaches are not mutually exclusive, and all involve some degree of benefit and risk. We explain why the parallel evaluation model may be the most appropriate approach for NICE as a first response to the increased demand for guidance on the environmental impact of health technologies. We also outline activities being undertaken by NICE and other agencies such as the Canadian Agency for Drugs and Technologies in Health to develop new methodologies for incorporating environmental impact data into their HTAs.

EE48 Can We Afford to Overlook the Cost of Avoidable Complications in Type 2 Diabetes: A Health Economic Analysis to Evaluate What Is the ‘Cost of Not’ Acting in Turkey?

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce cardiovascular (CV) and renal complications and prolong survival in patients with type 2 diabetes (T2D). The objective of this study is to quantify the economic value of short and long-term reductions in CV and renal complications associated with the use of SGLT2i in T2D against other glucose-lowering drugs (oGLD) or placebo.

EE605 Feasibility Assessment of Using MiToS Staging System for Conducting Health Economic Analysis in Amyotrophic Lateral Sclerosis (ALS)

The objective of this study was to assess feasibility of using Milano-Torino staging (MiToS) for developing a Markov model to conduct economic analysis in ALS.

PD13 Methodologies In Economic Evaluations Of Biomarkers – A Systematic Review

IntroductionDiagnostic testing and patient monitoring are important to diagnose potential diseases and to evaluate treatment regimens. Since diagnosis and treatment monitoring have no intrinsic effects, an economic evaluation of biomarkers is inevitably linked to the resulting therapeutic interventions, which depend on both physicians’ decisions and diagnostic accuracy of the test (i.e., sensitivity, specificity). In this review we analyzed the methodology of economic studies evaluating the management of the five most relevant non-communicable diseases, that is, obesity, cancer, diabetes, cardiovascular and chronic respiratory diseases.MethodsA systematic search in Medline and the National Health Service Economic Evaluation Database (NHS EED) covering the last ten years served to identify health economic analyses of biomarkers used in diagnosing / monitoring. Findings were reviewed with respect to analytical method, reported outcomes and comparability.ResultsThe search yielded 680 abstracts in total out of which 280 full texts were reviewed and 77 sources included following predefined criteria. Most economic analyses (94%) evaluated the clinical outcome and costs of testing / monitoring in correlation to a corresponding intervention, 6 percent of the sources focused on the accuracy of the test or monitoring methods only. There were 61 studies that included an economic model; overall, 15 sources presented the outcome as cost per life year gained (CEA), 37 sources as cost per QALY gained (CUA), and 12 provided the outcome as both a CEA and CUA. In 16 analyses the outcome was presented in other economic terms as, for example, cost per additional case detected.ConclusionsDetermining the value of biomarkers requires consideration of the clinical consequences of a test result (incorrect treatment decisions, impact on morbidity, mortality, or quality of life) as well as the corresponding economic outcomes. Most of the identified studies considered at least one of these aspects. Results are presented in manifold ways but do not necessarily address decision makers’ needs. Thus, clear guidelines on economic evaluations of biomarkers are needed and should include broader health system views like affordability or the number of unnecessary interventions avoided.

Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.

EE198 Integrating Health Economic Analysis into External Quality Assessment of Laboratory Tests: Evaluating Costs and Consequences of Bias in Lipid Tests in the Prevention of Cardiovascular Disease in Swedish Diabetes Patients

EE198 Integrating Health Economic Analysis into External Quality Assessment of Laboratory Tests: Evaluating Costs and Consequences of Bias in Lipid Tests in the Prevention of Cardiovascular Disease in Swedish Diabetes Patients

MT14 How Should Clinical Outcomes Factor Into Purchasing Decisions About Macintosh-Style Laryngoscopes?

Intubation with a Macintosh blade is a routine procedure in perioperative care and evidence demonstrates that video laryngoscopy (VL) improves intubation success versus direct laryngoscopy (DL). We wish to understand the type of health-economic analysis required to inform purchasing decisions between the two common VL devices, C-MAC and McGrath MAC.

PP34 Next Generation Sequencing For Informing Lung Cancer Therapy In Europe – Hospital Impact With A Lifecycle Perspective

IntroductionNext-generation sequencing (NGS) can be run in-house or outsourced to an independent laboratory. It has enabled wider use of deoxyribonucleic acid/ribonucleic acid (DNA + RNA) sequencing in clinical practice. Within oncology, NGS has paved the way for more effective treatment, including personalized medicine. There are, however, large variations in access and reimbursement across Europe. The aim is to understand the European NGS landscape and barriers to access.MethodsStructured telephone interviews covered topics on NGS perception, guidelines, use-cases, benefits, costs, and future expectations. Twelve experts per country (France, Germany, Italy, Spain): two payers, five oncologists, and five pathologists were interviewed between June and August 2021. Responses were translated into English for qualitative analysis.ResultsNGS was considered most useful when there were approved, targeted treatments. Although often noted that there was a lack of published evidence to support a beneficial link, respondents perceived that NGS has the potential to improve patient quality of life (QoL) and reduce resource use through avoiding suboptimal treatment. All of the payer respondents expected the role of NGS to increase, though it may be held back by lack of reimbursement. Respondents favored in-house NGS over outsourcing in terms of clinical benefit: “Advantages of in-house NGS are turnaround time, results and lean processes” … “you build the expertise in-house. If you have urgent samples, it’s easy to prioritize them”. Reasons for not having in-house NGS included “costs, lack of personnel. Basically, organizational and financial issues.” In-house NGS was perceived to be associated with high setup-costs (acquisition, setup, training), but lower running costs (per-test costs). There was a view that in-house solutions are mainly suitable in larger centers undertaking many tests.ConclusionsNGS can save costs and provide QoL benefit through enabling optimized, personalized therapy, but published evidence establishing the outcomes link is lacking. From the hospital perspective, investing in NGS requires understanding the cost of NGS over its entire lifecycle, likely entailing a health-technology assessment including health-economic analysis.

Extensions of Health Economic Evaluations in R for Microsoft Excel Users: A Tutorial for Incorporating Heterogeneity and Conducting Value of Information Analyses.

Advanced health economic analysis techniques currently performed in Microsoft Excel, such as incorporating heterogeneity, time-dependent transitions and a value of information analysis, can be easily transferred to R. Often the outputs of survival analyses (such as Weibull regression models) will estimate the impacts of correlated patient characteristics on patient outcomes, and are utilised directly as inputs for health economic decision models. This tutorial provides a step-by-step guide of how to conduct such analyses with a Markov model developed in R, and offers a comparison with established analyses performed in Microsoft Excel. This is done through the conversion of a previously published Microsoft Excel case study of a hip replacement surgery cost-effectiveness model. We hope that this paper can act as a facilitator in switching decision models from Microsoft Excel to R for complex health economic analyses, providing open-access code and data, suitable for future adaptation.

Cancer patient management: Current use of next-generation sequencing in the EU TOP4

BackgroundNext-generation sequencing (NGS) is recognised by a growing audience of medical professionals as a functional diagnostic tool in oncology. However, adoption in clinical routine proceeds haphazardly in Europe. MethodsA semi-structured interview survey was administered to 68 cancer care professionals in four EU countries between June-August and November-December 2021. Pre-screening questionnaires assessed sufficient NGS expertise, diverse geographical distribution, and professional roles. ResultsOur findings provide a better understanding of current clinical, regulatory, and reimbursement practices for NGS in four EU countries. ConclusionsDespite the impending European In-vitro Diagnostic Medical Devices Regulation (IVDR), tortuous national guidelines implementations and limping reimbursement policies are common traits across surveyed countries and produce disparity in access to advanced healthcare services amid regional distinctions. Policy summaryThe evident information gap between involved parties and demand for consistent national guidelines could be filled by health economics analyses tailored to local specifics to provide factual leverage for a structured adoption of NGS testing.

A review of the cost-effectiveness of genetic testing for germline variants in familial cancer

BackgroundTargeted germline testing is recommended for those with or at risk of breast, ovarian, or colorectal cancer. The affordability of genetic sequencing has improved over the past decade, therefore the cost-effectiveness of testing for these cancers is worthy of reassessment.ObjectiveTo systematically review economic evaluations on cost-effectiveness of germline testing in breast, ovarian, or colorectal cancer.MethodsA search of PubMed and Embase databases for cost-effectiveness studies on germline testing in breast, ovarian, or colorectal cancer, published between 1999 and May 2022. Synthesis of methodology, cost-effectiveness, and reporting (CHEERS checklist) was performed.ResultsThe incremental cost-effectiveness ratios (ICERs; in 2021-adjusted US$) for germline testing versus the standard care option in hereditary breast or ovarian cancer (HBOC) across target settings were as follows: (1) population-wide testing: 344–2.5 million/QALY; (2) women with high-risk: dominant = 78,118/QALY, 8,337–59,708/LYG; (3) existing breast or ovarian cancer: 3,012–72,566/QALY, 39,835/LYG; and (4) metastatic breast cancer: 158,630/QALY. Likewise, ICERs of germline testing for colorectal cancer across settings were: (1) population-wide testing: 132,200/QALY, 1.1 million/LYG; (2) people with high-risk: 32,322–76,750/QALY, dominant = 353/LYG; and (3) patients with existing colorectal cancer: dominant = 54,122/QALY, 98,790–6.3 million/LYG. Key areas of underreporting were the inclusion of a health economic analysis plan (100% of HBOC and colorectal studies), engagement of patients and stakeholders (95.4% of HBOC, 100% of colorectal studies) and measurement of outcomes (18.2% HBOC, 38.9% of colorectal studies).ConclusionGermline testing for HBOC was likely to be cost-effective across most settings, except when used as a co-dependent technology with the PARP inhibitor, olaparib in metastatic breast cancer. In colorectal cancer studies, testing was cost-effective in those with high-risk, but inconclusive in other settings. Cost-effectiveness was sensitive to the prevalence of tested variants, cost of testing, uptake, and benefits of prophylactic measures. Policy advice on germline testing should emphasize the importance of these factors in their recommendations.

Effects of add-on Celecoxib treatment on patients with schizophrenia spectrum disorders and inflammatory cytokine profile trial (TargetFlame): study design and methodology of a multicentre randomized, placebo-controlled trial

Neuroinflammation has been proposed to impact symptomatology in patients with schizophrenia spectrum disorders. While previous studies have shown equivocal effects of treatments with add-on anti-inflammatory drugs such as Aspirin, N-acetylcysteine and Celecoxib, none have used a subset of prospectively recruited patients exhibiting an inflammatory profile. The aim of the study is to evaluate the efficacy and safety as well as the cost-effectiveness of a treatment with 400 mg Celecoxib added to an ongoing antipsychotic treatment in patients with schizophrenia spectrum disorders exhibiting an inflammatory profile. The “Add-on Celecoxib treatment in patients with schizophrenia spectrum disorders and inflammatory cytokine profile trial (TargetFlame)” is a multicentre randomized, placebo-controlled phase III investigator-initiated clinical trial with the following two arms: patients exhibiting an inflammatory profile receiving either add-on Celecoxib 400 mg/day or add-on placebo. A total of 199 patients will be assessed for eligibility by measuring blood levels of three pro-inflammatory cytokines, and 109 patients with an inflammatory profile, i.e. inflamed, will be randomized, treated for 8 weeks and followed-up for additional four months. The primary endpoint will be changes in symptom severity as assessed by total Positive and Negative Syndrome Scale (PANSS) score changes from baseline to week 8. Secondary endpoints include various other measures of psychopathology and safety. Additional health economic analyses will be performed. TargetFlame is the first study aimed at evaluating the efficacy, safety and cost-effectiveness of the antiphlogistic agent Celecoxib in a subset of patients with schizophrenia spectrum disorders exhibiting an inflammatory profile. With TargetFlame, we intended to investigate a novel precision medicine approach towards anti-inflammatory antipsychotic treatment augmentation using drug repurposing. Clinical trial registration:http://www.drks.de/DRKS00029044 and https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00029044

Alberta Cellular and Immunotherapy (ACIT) 001, Results of Decentralized Production of Second Generation, Anti-CD19/41BB/CD3z Chimeric Antigen Receptor (CAR) T-Cells in Relapsed/Refractory (R/R) Acute Lymphoblastic Leukemia (ALL) and Aggressive Non-Hodgkin Lymphoma (NHL)

Purpose Anti-CD19 CAR T-cells are a standard treatment for aggressive B-cell cancers. Decentralized production may improve access to this important treatment and provide a platform for additional translational science in a single payer, public health care system such as Canada where implementation of CAR T-cells has been non-uniform and slow. ACIT001/EXC002 is a phase 1b/2 clinical trial examining the feasibility, safety, and efficacy of decentralized production of anti-CD19 CAR T-cell using the CliniMACS Prodigy bioreactor to treat R/R ALL and NHL patients. We report the phase 1b results in adults. Methods ACIT001/EXC002 launched following ethics approval with 2 manufacturing sites to service 4 clinical delivery sites. The phase 1b study used a 3+3 dose escalation design with two arms, one for adults (NHL or ALL, competitive enrollment) and one for children (ALL). CD19 expression was confirmed on their fresh or archival tumor samples and all patients had received a minimum of 2 prior lines of therapy. Patients with transformed disease or central nervous system involvement were allowed to participate. Anti-CD19 CAR T-cells were manufactured using freshly apheresed peripheral blood T-cells using a Lentigen anti-CD19 vector. Patients received cyclophosphamide (500 mg/m2) and fludarabine (30 mg/m2) as outpatient intravenous lymphodepleting chemotherapy on Days -5, -4 and -3 prior to infusion of CAR T-cells. Infusion of fresh CAR T-cells was favored but cryopreservation was permitted if clinical circumstances dictated a delay between apheresis and treatment. Patients were suggested to remain in hospital for 7 days at minimum but length of stay was not mandated. Results 10 patients were accrued to the phase 1b portion of the study. One extra patient was accrued due to an unexpected, treatment unrelated death (COVID 19). In-specification products were manufactured for each of the 9 evaluable patients (5 NHL and 4 ALL) and all patients received fresh CAR T-cells a median of 14 days after apheresis ("vein-to-vein", range 14-15 days). Grade 1 or 2 cytokine release syndrome (CRS) occurred in 7 (78%) of patients; tocilizumab was used in 5 (56%) of patients. Grade 1 or 2 Neurotoxicity (ICANS) occurred in 2 (22%) patients, and responded to limited dexamethasone. Median length of stay in hospital was 11 days (range 9-17 days). Investigator-assessed, objective response rate was 78% (7 of 9). All 4 ALL patients demonstrated a complete response (CR) to therapy with 3 negative for minimal residual disease (MRD) by flow cytometry (10-4). 3 (75%) of NHL patients showed a response to therapy including 2 CR's. With a median 8 months of follow-up time, 5 patients remain in remission (3 ALL, 2 NHL). Of 3 NHL patients demonstrating progression on trial, 1 had partial response prior to progression and 2 had refractory disease. T-cell exhaustion was associated with poor response to CAR T-cell therapy (see related abstract). Additional correlative analyses and health economics analyses are underway. Summary Our phase 1b results provide evidence that decentralized production is feasible in a single payer, public health care system. With a consistent vein-to-vein time of 14 days, we remove the inconsistency of manufacturing windows from standard of care products and have direct control over supply of CAR T-cells for our patient population. This method also implies that having smaller local manufacturing facilities allows a savings of scale while promoting improved and faster service than the creation and maintenance of a large, centralized manufacturing facility. This particular CAR T-cell product demonstrates a safety profile and efficacy similar to standard-of-care products through completion of the phase 1b portion of this trial. These results have prompted expansion to phase 2 in separate arms for ALL and NHL.

Systematic literature review of health economic models developed for multiple myeloma to support future analyses

AimsThe goal of this study was to review the economic evaluations of health technologies in multiple myeloma (MM) and provide guidance and recommendations for future health economic analyses.Materials and methodsA systemic literature review (SLR) was conducted on original economic assessment studies and structured review papers focusing on the studies in MM. The search was limited to English language papers published from 1 January 2000 onwards. Publications not applying any type of modelling methodology to describe disease progression and patient pathways over a specific time horizon were excluded.ResultsA total of 2,643 publications were initially identified, of which 148 were eligible to be included in the full-text review phase. From these, 49 publications were included in the final analysis. Most published health economic analyses supported by models came from high-income countries. Evaluations from middle-income countries were rarely published. Diagnostic technologies were rarely modelled and integrated care had not been modelled. Very few models investigated MM treatments from a societal perspective and there was a relative lack of evaluations regarding minimal residual disease (MRD).LimitationsLimitations of the publications included differences between trial populations and modelled populations, justification of methods, lack of confounder analyses, and small trial populations. Limitations of our study included the infeasibility of comparing MM economic evaluations due to the significant variance in modelled therapeutic lines and indications, and the relative scarcity of published economic evaluations from non-high-income countries.ConclusionsAs published economic models lacked many of the elements of the complex and heterogeneous patient pathways in MM and they focused on single decision problems, a thorough, open-source economic whole disease modelling framework is needed to assess the economic value of a wide range of technologies across countries with various income levels with a more detailed view on MM, by including patient-centric and societal aspects.

Abstract 12446: Effectiveness of a Digital Health Enabled Cardiac Rehabilitation Program in Reducing Recurrent Events For Private Health Insurance Patients in Australia

Introduction: Secondary prevention programs are paramount to avoid cardiovascular disease morbidity and mortality. However, they are underutilized. Technology-enabled programs provide a new frontier to break down access barriers and enhance health service delivery. We implemented a telehealth program using a cardiac rehabilitation (CR) mobile app for privately insured patients following a hospitalization for coronary heart disease. Hypothesis: It was hypothesized that patients participating in a digitally-enabled CR program would have improved health behaviors and less recurrent events at 30-days to 12-months post discharge compared with propensity matched controls. Methods: Eligible patients received the Smart-CR mobile app, supplemented with telehealth consultations. Clinical and lifestyle changes, psychological well-being, quality of life and medication adherence were assessed at the beginning and 8-weeks following participation in the program. Using propensity matching methods, we compared rehospitalization and mortality rates of the digital-CR group (n=160) with a traditionally delivered CR group (n=115) and patients who did not undertake any form of CR (n=266). Results: Among 160 patients (35% regional/remote, 70% male and 78% aged over 60 years), physical activity levels increased from 128 minutes/week to 300 minutes/week and systolic blood pressure decreased by 5 mmHg. There were improvements in most other clinical, behavioral and lifestyle risk factors, including functional capacity, depression, anxiety, and quality of life. At 60 days, digital-CR reduced cardiac-related readmissions by 52% (RR 0.48; 95% CI: 0.24 to 0.93) compared to no CR. At 90 days, traditional CR decreased all cause readmissions by 36% (RR 0.64; 95% CI: 0.44 to 0.94) compared to non-attendance to CR. There were no other pairwise differences between groups at 30, 60 or 90 days. Health economic analyses and extended outcomes to 12 months post hospitalization are in process. Conclusion: A remotely delivered, technology-enabled CR program was effective in reducing hospital readmissions and improving cardiovascular risk. A randomized controlled trial is underway to test the generalizability of these findings in community participants.

Abstract 10560: Cost-Effectiveness of AF Screening With 2-Week Patch Monitors: The Mhealth Screening to Prevent Strokes Study

Introduction. The mHealth Screening to Prevent Strokes (mSToPS) study reported that, compared with standard care, screening older Americans for AF using 2-week Zio patch monitors increased AF diagnosis and oral anticoagulant prescription within one year. The monitored group was also observed to have fewer strokes and deaths at 3 years. The cost-effectiveness of AF screening in this manner has not been explored. Methods. We conducted a health economic analysis of AF screening with Zio patch monitors using patient-level data from the mSToPS study. Clinical outcomes and costs from the payer perspective were obtained from enrollment through 3 years using Aetna claims data. Individual costs, survival and quality-adjusted survival (QALYs) were projected over a lifetime horizon using regression modeling, US life tables and external literature where needed. Potential imbalances between groups were adjusted for with propensity score bin bootstrapping. Results. Study group participants (mean age 74 years, 41% female, median CHA 2 DS 2 -VASC score 3) wore an average of 1.7 two-week monitors at an average cost of $601/person. Over 3 years, monitored individuals were more likely than unmonitored to have outpatient visits, including to cardiology, but less likely to require emergency department visits or hospitalization (see Table). Pharmacy costs over 3 years were similar between groups. Total adjusted 3-year costs, including monitors, were slightly higher (difference $1,170, 95% CI -1315 to 3657) in the monitoring group. In patient-level projections, the monitoring group had slightly better total and quality-adjusted survival (11.91 vs. 11.82 life years, 9.38 vs. 9.30 QALYs) and slightly higher lifetime costs, resulting in an incremental cost-effectiveness ratio of $16,978/QALY gained. Conclusions. Based on lifetime projections derived from the mSToPS study, we found AF screening using 2-week Zio patch monitors to provide high value from a health economic perspective.