The cost-effectiveness of a uniform versus age-based threshold for one-off screening for prevention of cardiovascular disease
(2023) In European Journal of Health Economics 24(7). p.1033-1045- 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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiovascular disease, Cost-effectiveness, Framingham risk score, Screening, Spain, Statins
- in
- European Journal of Health Economics
- volume
- 24
- issue
- 7
- pages
- 1033 - 1045
- publisher
- Springer
- external identifiers
-
- pmid:36239877
- scopus:85140227085
- ISSN
- 1618-7598
- DOI
- 10.1007/s10198-022-01533-y
- language
- English
- LU publication?
- yes
- id
- e9c2be31-933f-4b53-a51f-c96ddcdc867d
- date added to LUP
- 2023-01-16 14:39:57
- date last changed
- 2024-06-13 01:43:55
@article{e9c2be31-933f-4b53-a51f-c96ddcdc867d,
abstract = {{<p>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.</p>}},
author = {{Špacírová, Zuzana and Kaptoge, Stephen and García-Mochón, Leticia and Rodríguez Barranco, Miguel and Sánchez Pérez, María José and Bondonno, Nicola P. and Tjønneland, Anne and Weiderpass, Elisabete and Grioni, Sara and Espín, Jaime and Sacerdote, Carlotta and Schiborn, Catarina and Masala, Giovanna and Colorado-Yohar, Sandra M. and Kim, Lois and Moons, Karel G.M. and Engström, Gunnar and Schulze, Matthias B. and Bresson, Léa and Moreno-Iribas, Concepción and Epstein, David}},
issn = {{1618-7598}},
keywords = {{Cardiovascular disease; Cost-effectiveness; Framingham risk score; Screening; Spain; Statins}},
language = {{eng}},
number = {{7}},
pages = {{1033--1045}},
publisher = {{Springer}},
series = {{European Journal of Health Economics}},
title = {{The cost-effectiveness of a uniform versus age-based threshold for one-off screening for prevention of cardiovascular disease}},
url = {{http://dx.doi.org/10.1007/s10198-022-01533-y}},
doi = {{10.1007/s10198-022-01533-y}},
volume = {{24}},
year = {{2023}},
}