Health watchdog finds stroke screening cost-effective

The case for introducing a national screening programme to help identify over 65s who are most at risk of stroke has been given added impetus after the State’s health watchdog found that it is likely to be cost-effective.

Health watchdog finds stroke screening cost-effective

The Health Information and Quality Authority (Hiqa) estimates that such a screening programme would result in the detection of one additional case of atrial fibrillation for every 22 people screened from age 65 onwards, and one stroke avoided for every 270 people screened over the same period.

Hiqa’s economic evaluation of a national screening programme for atrial fibrillation believes it could be done at a total incremental cost to the HSE of approximately €3.7m over the first five years.

The Hiqa finding is a boost for the recommendation of the National Cardiovascular Policy 2010-2019, which calls for an atrial fibrillation screening programme.

Hiqa’s director of health technology assessment, Máirín Ryan, said that, based on the best available evidence, “annual opportunistic pulse palpation for those aged 65 and older is expected to lead to reductions in the incidence and severity of atrial fibrillation-related strokes”. That is while assuming that those detected by screening have a comparable risk of stroke as those detected through routine care.

Dr Ryan said that the estimated €3.7m cost of the screening programme included the additional costs associated with screening ECGs and atrial fibrillation drug therapy in diagnosed cases, “as well as the cost savings resulting from a gradual decrease in stroke incidence over a period of five years”.

Atrial fibrillation is the most common abnormal heart rhythm to be observed during general practice and is associated with a fivefold increase in the risk of stroke. Strokes related to atrial fibrillation are also more severe, with twice the death rate of non-atrial fibrillation-related strokes and resulting in greater functional deficits for those who do survive such strokes.

There are about 8,000 strokes in Ireland annually; approximately a third of which are associated with atrial fibrillation.

In a statement last night, the HSE said that it “will study this report and consider the recommendations and resource implications associated with a national screening programme for atrial fibrillation”.

The full atrial fibrillation document can at www.hiqa.ie/publications/health-technology-assessment-hta-national-screening-programme-atrial-fibrillation-prima.

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