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

Zuzana Špacírová (), Stephen Kaptoge, Leticia García-Mochón, Miguel Rodríguez Barranco, María José Sánchez Pérez, Nicola P. Bondonno, Anne Tjønneland, Elisabete Weiderpass, Sara Grioni, Jaime Espín, Carlotta Sacerdote, Catarina Schiborn, Giovanna Masala, Sandra M. Colorado-Yohar, Lois Kim, Karel G. M. Moons, Gunnar Engström, Matthias B. Schulze, Léa Bresson, Concepción Moreno-Iribas and David Epstein
Additional contact information
Zuzana Špacírová: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Stephen Kaptoge: University of Cambridge
Leticia García-Mochón: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Miguel Rodríguez Barranco: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
María José Sánchez Pérez: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Nicola P. Bondonno: The Danish Cancer Society Research Centre
Anne Tjønneland: The Danish Cancer Society Research Centre
Elisabete Weiderpass: International Agency for Research on Cancer, World Health Organization
Sara Grioni: Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
Jaime Espín: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Carlotta Sacerdote: Città della Salute e della Scienza University-Hospital
Catarina Schiborn: German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE)
Giovanna Masala: Institute for Cancer Research, Prevention and Clinical Network – ISPRO
Sandra M. Colorado-Yohar: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Lois Kim: University of Cambridge
Karel G. M. Moons: UMC Utrecht, Trecht University
Gunnar Engström: Lund University
Matthias B. Schulze: German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE)
Léa Bresson: Ubisoft France
Concepción Moreno-Iribas: Navarra Public Health Institute
David Epstein: IdiSNA, Navarra Institute for Health Research

The European Journal of Health Economics, 2023, vol. 24, issue 7, No 3, 1033-1045

Abstract: 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.

Keywords: Cardiovascular disease; Statins; Screening; Framingham risk score; Spain; Cost-effectiveness (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10198-022-01533-y

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