{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:13:14Z","timestamp":1784297594225,"version":"3.55.0"},"reference-count":45,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Early diagnosis and treatment of atrial fibrillation (AF) are crucial to reduce AF-related complications and associated healthcare costs. In low-resource settings, digital health technologies could help achieve this; however, costs of different screening strategies are key for policy change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This decision-tree model representing the Sri Lankan public health system perspective used prevalence data from a community-based cross-sectional study of 10\u2009000 individuals aged \u226550 years in Northern Province, Sri Lanka. Participants were screened for AF using AliveCor, a handheld single-lead ECG device. Three screening strategies (systematic, opportunistic and targeted) were compared against each other. The incremental cost-effectiveness ratio (ICER) is presented, representing the incremental total aggregated cost between screening strategies divided by the incremental number of new detected AF cases to generate a cost per additional new AF cases detected for a 1-year time horizon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Systematic screening detected 48 new AF cases, and the targeted screening detected 47. Systematic screening was more expensive (Sri Lankan rupees (Rs) 698 422; US$2123) for 10\u2009000 screened individuals compared with targeted screening (Rs 492 002; US$1496) for 7780 screened individuals. Opportunistic screening was the cheapest strategy (Rs 360 617; US$1096) for screening 6556 individuals; however, only 30 new AF cases were identified. The ICER of targeted screening was lower compared with opportunistic screening (Rs 7729; US$23 per additional detected AF case) whereas the ICER of systematic screening compared with opportunistic screening was higher at Rs 18\u2009767 (US$57) per detected AF case. When the systematic screening strategy was compared with targeted screening, the cost per additional detected AF case increased to Rs 206\u2009420 ($628).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Targeted screening with AliveCor was the most cost-effective strategy. Systematic screening, while having similar effectiveness, was not cost-effective due to the high additional costs to detect just one further case. These findings support integrating targeted screening into Sri Lanka\u2019s primary care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2025-019592","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T14:20:35Z","timestamp":1773411635000},"page":"e019592","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of three screening strategies for atrial fibrillation in Sri Lanka: a decision-tree modelling analysis using community-based prevalence data"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-9503","authenticated-orcid":false,"given":"Shribavan","family":"Kanesamoorthy","sequence":"first","affiliation":[{"name":"Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri 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