TY - JOUR

T1 - The cost-effectiveness of a uniform versus age-based threshold for one-off screening for prevention of cardiovascular disease

AU - Spacirova, Zuzana

AU - Kaptoge, Stephen

AU - Garcia-Mochon, Leticia

AU - Rodriguez Barranco, Miguel

AU - Sanchez Perez, Maria Jose

AU - Bondonno, Nicola P.

AU - Tjønneland, Anne

AU - Weiderpass, Elisabete

AU - Grioni, Sara

AU - Espin, Jaime

AU - Sacerdote, Carlotta

AU - Schiborn, Catarina

AU - Masala, Giovanna

AU - Colorado-Yohar, Sandra M.

AU - Kim, Lois

AU - Moons, Karel G. M.

AU - Engstrom, Gunnar

AU - Schulze, Matthias B.

AU - Bresson, Lea

AU - Moreno-Iribas, Concepcion

AU - Epstein, David

PY - 2023

Y1 - 2023

N2 - 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 euro3,274/QALY and euro6,085/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.

AB - 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 euro3,274/QALY and euro6,085/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.

KW - Cardiovascular disease

KW - Statins

KW - Screening

KW - Framingham risk score

KW - Spain

KW - Cost-effectiveness

KW - GENERAL-POPULATION

KW - HEALTH-BENEFITS

KW - STATIN

KW - RISK

KW - GUIDELINES

KW - MODELS

KW - IMPACT

KW - CARE

U2 - 10.1007/s10198-022-01533-y

DO - 10.1007/s10198-022-01533-y

M3 - Journal article

C2 - 36239877

VL - 24

SP - 1033

EP - 1045

JO - European Journal of Health Economics

JF - European Journal of Health Economics

SN - 1618-7598

ER -