Background Strokes cause an estimated annual health care burden of 170
billion euros across Europe. Atrial fibrillation is one of the major
risk factors for stroke and increases the individual risk 4.2-fold. But
prevention with anticoagulants may reduce this risk by 70%. Screening
methods are employed to detect previously undetected atrial
fibrillation. Screening studies in various European countries show a
high degree of undetected atrial fibrillation. This study aims to assess
the cost-effectiveness of systematic screening with a smartphone
application, named Preventicus Heartbeats. It is a hands-on screening
tool for use on smartphone to diagnose AF with high sensitivity and
specificity. Methods A previously published model for calculating
screening cost-effectiveness was extended to 6 European countries
covering a wide range in terms of treatment costs and epidemiologic
parameters. Results The use of screening lowers the cost per case in
countries with comparatively high levels of health care costs
(Switzerland: -euro75; UK: -euro7). Moderate higher costs per case were
observed in 4 countries (Greece: euro6; Netherlands: euro15). Low levels
of health care costs result in less or no potential for further cost
reduction (Poland: euro20; Serbia: euro33). In all countries considered,
the model showed an increase in effectiveness measures both in the
number of strokes avoided and the quality adjusted life years. The
number of strokes avoided per 1000 participants ranged from 2.52
(Switzerland) to 4.44 (Poland). Quality-adjusted life-years per case
gained from screening ranged from 0.0105 (Switzerland) to 0.0187
(Poland). The screening procedure dominated in two countries
(Switzerland, UK). For the remaining countries, the incremental cost
effectiveness ratio ranged from euro489/QALY (Greece) to euro2548/QALY
(Serbia). Conclusion The model results showed a strong dependence of the
results on the country-specific costs for stroke treatment. The use of
the investigated screening method is close to cost-neutral or
cost-reducing in the Western European countries and Greece. In countries
with low price levels, higher cost increases due to AF screening are to
be expected. Lower costs of anticoagulation, which are expected due to
the upcoming patent expiry of direct anticoagulants, have a positive
effect on the cost result