A Standardized Vascular Disease Health Check in Europe: A Cost-Effectiveness Analysis

Abstract

BackgroundNo clinical trials have assessed the effects or cost-effectiveness of health check strategies to detect and manage vascular disease. We used a mathematical model to estimate the cost-effectiveness of several health check strategies in six European countries.MethodsWe used country-specific data from Denmark, France, Germany, Italy, Poland, and the United Kingdom to generate simulated populations of individuals aged 40–75 eligible for health checks in those countries (e.g. individuals without a previous diagnosis of diabetes, myocardial infarction, stroke, or serious chronic kidney disease). For each country, we used the Archimedes model to compare seven health check strategies consisting of assessments for diabetes, hypertension, lipids, and smoking. For patients diagnosed with vascular disease, treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, major adverse cardiovascular events (MACE), and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY).ResultsCompared with current care, health checks reduced the incidence of MACE (6–17 events prevented per 1000 people screened) and diabetes related microvasular complications (5–11 events prevented per 1000 people screened), and increased QALYs (31–59 discounted QALYs) over 30 years, in all countries. The cost per QALY of offering a health check to all individuals in the study cohort ranged from €14903 (France) to cost saving (Poland). Pre-screening the population and offering health checks only to higher risk individuals lowered the cost per QALY. Pre-screening on the basis of obesity had a cost per QALY of €10200 (France) or less, and pre-screening with a non-invasive risk score was similar.ConclusionsA vascular disease health check would likely be cost effective at 30 years in Denmark, France, Germany, Italy, Poland, and the United Kingdom.

Effect of screening for type 2 diabetes on risk of cardiovascular disease and mortality: a controlled trial among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009

“…Our findings support results from modelling studies showing that screening programmes could contribute to a reduction in risk of mortality and cardiovascular morbidity in screen-detected individuals [1][2][3][4][5]. Herman et al used a validated computer simulation model in ADDITION-Europe to show that screening and routine care, compared with a 3 year delay in diagnosis and routine care, was associated with a 17% relative risk reduction in all-cause mortality after 5 years [5].…”

“…Modelling studies suggest that screening might be both effective and costeffective [1][2][3][4][5]. Screening and early treatment for diabetes appear to be associated with limited harms [6,7].…”

Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events: a controlled trial among 1,912,392 Danish adults

“…Similarly, rates of cardiovascular-, cancer-and diabetes-related mortality were not reduced by invitation to screening. Modelling studies have previously suggested a benefit of population screening for diabetes and related risk factors for vascular disease [3][4][5][6][7]. This finding was supported by examination of the Ely cohort [22], in which individuals aged 40-65 years who were invited to diabetes screening every 5 years between 1990 and 1999 had a non-significant 21% lower all-cause mortality rate than individuals who were not invited to screening; however, this finding was not replicated in between 2000 and 2008.…”

“…These usually include assessment and management of risk factors for chronic disease, most of which are related to cardiovascular disease (CVD). Modelling studies suggest that screening for diabetes and cardiovascular risk assessment might be both effective and cost-effective; however, these studies rely on a number of assumptions [3][4][5][6][7]. There are relatively few trials assessing the benefits and harms of screening at the population level [8,9].…”

Targeted case finding in the prevention of cardiovascular disease: a stepped wedge cluster randomised controlled trial

“…Systematic health checks are policy in the UK and have been proposed across a number of countries. 13,14 Systematic health checks have not been shown to be effective and this may be due to a failure to identify eligible patients, initiate treatment, or continue with treatment. 15,16 If they are to be effective, health checks must identify and treat high-risk patients.…”