Amy B. Stein
Current Organizations / Institutes
The organizations/institutes from the scholar's latest article
Research Subjects
Amy B. Stein has a total of 5 co-authors. Here are the top co-authors by number of shared publications:
- David J. Cohen
St. Francis Hospital and Heart Center, Roslyn, NY (D.J.C.).
1 shared publication - Evangelos Hytopoulos
Rhythm, San Francisco, CA (E.H.).
1 shared publication - Matthew R. Reynolds
Lahey Hospital & Medical Center Burlington Massachusetts USA
1 shared publication - Steven R. Steinhubl
Weldon School of Biomedical Engineering, Purdue University , West Lafayette
1 shared publication - Xiaowu Sun
CVS Health, Woonsocket, RI 02895, USA
1 shared publication
Latest Publications
- Open Access
- 1 November 2023
- Published by Wolters Kluwer Health in Circulation: Cardiovascular Quality and Outcomes
- Vol. 16 (11) , e009751
Cost-Effectiveness of AF Screening With 2-Week Patch Monitors: The mSToPS Study
BACKGROUND: The mSToPS study (mHealth Screening to Prevent Strokes) reported screening older Americans at risk for atrial fibrillation (AF) and stroke using 2-week patch monitors was associated with increased rates of AF diagnosis and anticoagulant prescription within 1 year and improved clinical outcomes at 3 years relative to matched controls. Cost-effectiveness of this AF screening approach has not been explored. METHODS: We conducted a US-based health economic analysis of AF screening using patient-level data from mSToPS. Clinical outcomes, resource use, and costs were obtained through 3 years using claims data. Individual costs, survival, and quality-adjusted life years (QALYs) were projected over a lifetime horizon using regression modeling, US life tables, and external data where needed. Adjustment between groups was performed using propensity score bin bootstrapping. RESULTS: Screening participants (mean age, 74 years, 41% female, median CHA 2 DS 2 -VASC score 3) wore on average 1.7 two-week monitors at a mean cost of $614/person. Over 3 years, outpatient visits were more frequent for monitored than unmonitored individuals (difference 190 per 100 patient-years [95% CI, 82–298]), but emergency department visits (−8.3 [95% CI, −12.6 to −4.1]) and hospitalizations (−15.2 [CI, −22 to −8.6]) were less frequent. Total adjusted 3-year costs were slightly higher (mean difference, $1551 [95% CI, −$1047 to $4038]) in the monitoring group. In patient-level projections, the monitoring group had slightly greater quality-adjusted survival (8.81 versus 8.71 QALYs, difference, 0.09 [95% CI, −0.05 to 0.24]) and slightly higher lifetime costs, resulting in an incremental cost-effectiveness ratio of $36 100/QALY gained. With bootstrap resampling, the incremental cost-effectiveness ratio for monitoring was <$50 000/QALY in 64% of study replicates, and <$150 000/QALY in 91%. CONCLUSIONS: Using lifetime projections derived from the mSToPS study, we found that AF screening using 2-week patch monitors in older Americans was associated with high economic value. Confirmation of these uncertain findings in a randomized trial is warranted. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02506244.
- 1 November 2023
- Published by Wolters Kluwer Health in Circulation: Cardiovascular Quality and Outcomes
- Vol. 16 (11) , e009751
Open AccessCost-Effectiveness of AF Screening With 2-Week Patch Monitors: The mSToPS Study
BACKGROUND: The mSToPS study (mHealth Screening to Prevent Strokes) reported screening older Americans at risk for atrial fibrillation (AF) and stroke using 2-week patch monitors was associated with increased rates of AF diagnosis and anticoagulant prescription within 1 year and improved clinical outcomes at 3 years relative to matched controls. Cost-effectiveness of this AF screening approach has not been explored. METHODS: We conducted a US-based health economic analysis of AF screening using patient-level data from mSToPS. Clinical outcomes, resource use, and costs were obtained through 3 years using claims data. Individual costs, survival, and quality-adjusted life years (QALYs) were projected over a lifetime horizon using regression modeling, US life tables, and external data where needed. Adjustment between groups was performed using propensity score bin bootstrapping. RESULTS: Screening participants (mean age, 74 years, 41% female, median CHA 2 DS 2 -VASC score 3) wore on average 1.7 two-week monitors at a mean cost of $614/person. Over 3 years, outpatient visits were more frequent for monitored than unmonitored individuals (difference 190 per 100 patient-years [95% CI, 82–298]), but emergency department visits (−8.3 [95% CI, −12.6 to −4.1]) and hospitalizations (−15.2 [CI, −22 to −8.6]) were less frequent. Total adjusted 3-year costs were slightly higher (mean difference, $1551 [95% CI, −$1047 to $4038]) in the monitoring group. In patient-level projections, the monitoring group had slightly greater quality-adjusted survival (8.81 versus 8.71 QALYs, difference, 0.09 [95% CI, −0.05 to 0.24]) and slightly higher lifetime costs, resulting in an incremental cost-effectiveness ratio of $36 100/QALY gained. With bootstrap resampling, the incremental cost-effectiveness ratio for monitoring was <$50 000/QALY in 64% of study replicates, and <$150 000/QALY in 91%. CONCLUSIONS: Using lifetime projections derived from the mSToPS study, we found that AF screening using 2-week patch monitors in older Americans was associated with high economic value. Confirmation of these uncertain findings in a randomized trial is warranted. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02506244.