Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia

Pablo Lázaro, Leopoldo Pérez de Isla, Gerald F. Watts, Rodrigo Alonso, Richard Norman, Ovidio Muñiz, Francisco Fuentes, Nelva Mata, José López-Miranda, José Ramón González-Juanatey, José Luis Díaz-Díaz, Antonio Javier Blasco, Pedro Mata

    Research output: Contribution to journalArticle

    23 Citations (Scopus)

    Abstract

    Background: Although familial hypercholesterolemia (FH) confers a high risk of coronary artery disease, most patients are undiagnosed, and little is known about the efficiency of genetic cascade screening programs at national level. Objective: The aim of the study was to estimate the cost-effectiveness of a national genetic cascade screening program in Spain. Methods: An economic evaluation was performed using a decision tree analysis. The choice in the decision tree was between implementation of the national program for FH (NPFH) or keeping the usual clinical care. The NPFH detects FH patients through total cholesterol measurement at primary care level and use of genetic testing in index cases and relatives. The payer (National Health System) and social (including the productivity lost) perspectives were considered. The outcome variables were coronary events avoided, deaths avoided, and quality-adjusted life years (QALYs) gained. Results: From the payer perspective, the application of the NPFH during 1 year prevents 847 coronary events and 203 deaths in the 9000 FH patients cohort during a 10-year follow-up, yielding an extra 767 QALYs, at a cost of €29,608 per QALY gained. From the social perspective, the NPFH is dominant over the control (the cost decreases and the effectiveness increases). The sensitivity analysis confirms the robustness of the findings. Conclusion: The NPFH based on molecular testing is a cost-effective diagnostic and management strategy that supports government expenditure aimed at preventing coronary artery disease in FH patients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.

    Original languageEnglish
    Pages (from-to)260–271
    JournalJournal of Clinical Lipidology
    Volume11
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2017

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    Hyperlipoproteinemia Type II
    Cost-Benefit Analysis
    Quality-Adjusted Life Years
    Genetic Testing
    Decision Trees
    Costs and Cost Analysis
    Spain
    Coronary Artery Disease
    Decision Support Techniques
    Health Expenditures
    Primary Health Care
    Cholesterol
    Delivery of Health Care
    Health

    Cite this

    Lázaro, Pablo ; Pérez de Isla, Leopoldo ; Watts, Gerald F. ; Alonso, Rodrigo ; Norman, Richard ; Muñiz, Ovidio ; Fuentes, Francisco ; Mata, Nelva ; López-Miranda, José ; González-Juanatey, José Ramón ; Díaz-Díaz, José Luis ; Blasco, Antonio Javier ; Mata, Pedro. / Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia. In: Journal of Clinical Lipidology. 2017 ; Vol. 11, No. 1. pp. 260–271.
    @article{58d545f0d7f54ba28ef6495ec9c0f341,
    title = "Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia",
    abstract = "Background: Although familial hypercholesterolemia (FH) confers a high risk of coronary artery disease, most patients are undiagnosed, and little is known about the efficiency of genetic cascade screening programs at national level. Objective: The aim of the study was to estimate the cost-effectiveness of a national genetic cascade screening program in Spain. Methods: An economic evaluation was performed using a decision tree analysis. The choice in the decision tree was between implementation of the national program for FH (NPFH) or keeping the usual clinical care. The NPFH detects FH patients through total cholesterol measurement at primary care level and use of genetic testing in index cases and relatives. The payer (National Health System) and social (including the productivity lost) perspectives were considered. The outcome variables were coronary events avoided, deaths avoided, and quality-adjusted life years (QALYs) gained. Results: From the payer perspective, the application of the NPFH during 1 year prevents 847 coronary events and 203 deaths in the 9000 FH patients cohort during a 10-year follow-up, yielding an extra 767 QALYs, at a cost of €29,608 per QALY gained. From the social perspective, the NPFH is dominant over the control (the cost decreases and the effectiveness increases). The sensitivity analysis confirms the robustness of the findings. Conclusion: The NPFH based on molecular testing is a cost-effective diagnostic and management strategy that supports government expenditure aimed at preventing coronary artery disease in FH patients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.",
    keywords = "Cardiovascular disease, Cascade screening program, Cost-effectiveness, Familial hypercholesterolemia",
    author = "Pablo L{\'a}zaro and {P{\'e}rez de Isla}, Leopoldo and Watts, {Gerald F.} and Rodrigo Alonso and Richard Norman and Ovidio Mu{\~n}iz and Francisco Fuentes and Nelva Mata and Jos{\'e} L{\'o}pez-Miranda and Gonz{\'a}lez-Juanatey, {Jos{\'e} Ram{\'o}n} and D{\'i}az-D{\'i}az, {Jos{\'e} Luis} and Blasco, {Antonio Javier} and Pedro Mata",
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    Lázaro, P, Pérez de Isla, L, Watts, GF, Alonso, R, Norman, R, Muñiz, O, Fuentes, F, Mata, N, López-Miranda, J, González-Juanatey, JR, Díaz-Díaz, JL, Blasco, AJ & Mata, P 2017, 'Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia' Journal of Clinical Lipidology, vol. 11, no. 1, pp. 260–271. https://doi.org/10.1016/j.jacl.2017.01.002

    Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia. / Lázaro, Pablo; Pérez de Isla, Leopoldo; Watts, Gerald F.; Alonso, Rodrigo; Norman, Richard; Muñiz, Ovidio; Fuentes, Francisco; Mata, Nelva; López-Miranda, José; González-Juanatey, José Ramón; Díaz-Díaz, José Luis; Blasco, Antonio Javier; Mata, Pedro.

    In: Journal of Clinical Lipidology, Vol. 11, No. 1, 01.01.2017, p. 260–271.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia

    AU - Lázaro, Pablo

    AU - Pérez de Isla, Leopoldo

    AU - Watts, Gerald F.

    AU - Alonso, Rodrigo

    AU - Norman, Richard

    AU - Muñiz, Ovidio

    AU - Fuentes, Francisco

    AU - Mata, Nelva

    AU - López-Miranda, José

    AU - González-Juanatey, José Ramón

    AU - Díaz-Díaz, José Luis

    AU - Blasco, Antonio Javier

    AU - Mata, Pedro

    PY - 2017/1/1

    Y1 - 2017/1/1

    N2 - Background: Although familial hypercholesterolemia (FH) confers a high risk of coronary artery disease, most patients are undiagnosed, and little is known about the efficiency of genetic cascade screening programs at national level. Objective: The aim of the study was to estimate the cost-effectiveness of a national genetic cascade screening program in Spain. Methods: An economic evaluation was performed using a decision tree analysis. The choice in the decision tree was between implementation of the national program for FH (NPFH) or keeping the usual clinical care. The NPFH detects FH patients through total cholesterol measurement at primary care level and use of genetic testing in index cases and relatives. The payer (National Health System) and social (including the productivity lost) perspectives were considered. The outcome variables were coronary events avoided, deaths avoided, and quality-adjusted life years (QALYs) gained. Results: From the payer perspective, the application of the NPFH during 1 year prevents 847 coronary events and 203 deaths in the 9000 FH patients cohort during a 10-year follow-up, yielding an extra 767 QALYs, at a cost of €29,608 per QALY gained. From the social perspective, the NPFH is dominant over the control (the cost decreases and the effectiveness increases). The sensitivity analysis confirms the robustness of the findings. Conclusion: The NPFH based on molecular testing is a cost-effective diagnostic and management strategy that supports government expenditure aimed at preventing coronary artery disease in FH patients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.

    AB - Background: Although familial hypercholesterolemia (FH) confers a high risk of coronary artery disease, most patients are undiagnosed, and little is known about the efficiency of genetic cascade screening programs at national level. Objective: The aim of the study was to estimate the cost-effectiveness of a national genetic cascade screening program in Spain. Methods: An economic evaluation was performed using a decision tree analysis. The choice in the decision tree was between implementation of the national program for FH (NPFH) or keeping the usual clinical care. The NPFH detects FH patients through total cholesterol measurement at primary care level and use of genetic testing in index cases and relatives. The payer (National Health System) and social (including the productivity lost) perspectives were considered. The outcome variables were coronary events avoided, deaths avoided, and quality-adjusted life years (QALYs) gained. Results: From the payer perspective, the application of the NPFH during 1 year prevents 847 coronary events and 203 deaths in the 9000 FH patients cohort during a 10-year follow-up, yielding an extra 767 QALYs, at a cost of €29,608 per QALY gained. From the social perspective, the NPFH is dominant over the control (the cost decreases and the effectiveness increases). The sensitivity analysis confirms the robustness of the findings. Conclusion: The NPFH based on molecular testing is a cost-effective diagnostic and management strategy that supports government expenditure aimed at preventing coronary artery disease in FH patients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.

    KW - Cardiovascular disease

    KW - Cascade screening program

    KW - Cost-effectiveness

    KW - Familial hypercholesterolemia

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    SP - 260

    EP - 271

    JO - Journal of Clinical Lipidology

    JF - Journal of Clinical Lipidology

    SN - 1876-4789

    IS - 1

    ER -