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The cost-effectiveness of a uniform versus age-based threshold for one-off screening for prevention of cardiovascular disease.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Špacírová, Zuzana  ORCID logo  https://orcid.org/0000-0002-2905-2934
Kaptoge, Stephen 
García-Mochón, Leticia 
Rodríguez Barranco, Miguel 
Sánchez Pérez, María José 

Abstract

The objective of this article was to assess the cost-effectiveness of screening strategies for cardiovascular diseases (CVD). A decision analytic model was constructed to estimate the costs and benefits of one-off screening strategies differentiated by screening age, sex and the threshold for initiating statin therapy ("uniform" or "age-adjusted") from the Spanish NHS perspective. The age-adjusted thresholds were configured so that the same number of people at high risk would be treated as under the uniform threshold. Health benefit was measured in quality-adjusted life years (QALY). Transition rates were estimated from the European Prospective Investigation into Cancer and Nutrition (EPIC-CVD), a large multicentre nested case-cohort study with 12 years of follow-up. Unit costs of primary care, hospitalizations and CVD care were taken from the Spanish health system. Univariate and probabilistic sensitivity analyses were employed. The comparator was no systematic screening program. The base case model showed that the most efficient one-off strategy is to screen both men and women at 40 years old using a uniform risk threshold for initiating statin treatment (Incremental Cost-Effectiveness Ratio of €3,274/QALY and €6,085/QALY for men and women, respectively). Re-allocating statin treatment towards younger individuals at high risk for their age and sex would not offset the benefit obtained using those same resources to treat older individuals. Results are sensitive to assumptions about CVD incidence rates. To conclude, one-off screening for CVD using a uniform risk threshold appears cost-effective compared with no systematic screening. These results should be evaluated in clinical studies.

Description

Keywords

Cardiovascular disease, Cost-effectiveness, Framingham risk score, Screening, Spain, Statins, Male, Humans, Female, Adult, Cardiovascular Diseases, Cost-Benefit Analysis, Cohort Studies, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Prospective Studies, Quality-Adjusted Life Years

Journal Title

Eur J Health Econ

Conference Name

Journal ISSN

1618-7598
1618-7601

Volume Title

Publisher

Springer Science and Business Media LLC
Sponsorship
Medical Research Council (G1000143)
Medical Research Council (G0800270)
European Research Council (268834)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
British Heart Foundation (RG/18/13/33946)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (G0401527)
Medical Research Council (MR/N003284/1)
Medical Research Council (G0800270/1)
Medical Research Council (G0401527/1)