Cost-Effectiveness of Screening Algorithms for Familial Hypercholesterolaemia in Primary Care

Jones, Matthew; Akyea, Ralph Kwame; Payne, Katherine; Humphries, Steve E.; Abdul-Hamid, Hasidah; Weng, Stephen; Qureshi, Nadeem

doi:10.3390/jpm12030330

Cited by 9 publications

(16 citation statements)

References 30 publications

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“…Of the 21 included studies, five studies were set in Australia [ 20 , 21 , 22 , 23 ], four in the UK [ 24 , 25 , 26 , 27 ], three in the Netherlands [ 19 , 28 , 29 ], two in England and Wales [ 18 , 30 ], two in Spain [ 31 , 32 ], two in the USA [ 33 , 34 ], one in Poland [ 35 ], one in Argentina [ 36 ], and one in Canada [ 37 ]. All the studies were reported in English.…”

Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Screening Strategies for Familial Hypercholesterolaemia: An Updated Systematic Review

Marquina,

Morton,

Lloyd

et al. 2024

PharmacoEconomics

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Background Objective This study aimed to systematically synthesise the cost-effectiveness of screening strategies to detect heterozygous familial hypercholesterolemia (FH). Methods We searched seven databases from inception to 2 February , 2023, for eligible cost-effective analysis (CEA) that evaluated screening strategies for FH versus the standard care for FH detection. Independent reviewers performed the screening, data extraction and quality evaluation. Cost results were adapted to 2022 US dollars (US$) to facilitate comparisons between studies using the same screening strategies. Cost-effectiveness thresholds were based on the original study criteria. Results A total of 21 studies evaluating 62 strategies were included in this review, most of the studies (95%) adopted a healthcare perspective in the base case, and majority were set in high-income countries. Strategies analysed included cascade screening (23 strategies), opportunistic screening (13 strategies), systematic screening (11 strategies) and population-wide screening (15 strategies). Most of the strategies relied on genetic diagnosis for case ascertainment. The most common comparator was no screening, but some studies compared the proposed strategy versus current screening strategies or versus the best next alternative. Six studies evaluated screening in children while the remaining were targeted at adults. From a healthcare perspective, cascade screening was cost-effective in 78% of the studies [cost-adapted incremental cost-effectiveness ratios (ICERs) ranged from dominant to 2022 US$ 104,877], opportunistic screening in 85% (ICERs from US$4959 to US$41,705), systematic screening in 80% (ICERs from US$2763 to US$69,969) and population-wide screening in 60% (ICERs from US$1484 to US$223,240). The most common driver of ICER identified in the sensitivity analysis was the long-term cost of lipid-lowering treatment. Conclusions Based on reported willingness to pay thresholds for each setting, most CEA studies concluded that screening for FH compared with no screening was cost-effective, regardless of the screening strategy. Cascade screening resulted in the largest health benefits per person tested. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-023-01347-7.

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Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Screening Strategies for Familial Hypercholesterolaemia: An Updated Systematic Review

Marquina,

Morton,

Lloyd

et al. 2024

PharmacoEconomics

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“…We estimate that screening of all eligible adult healthcare records in this age-bracket would yield 24,564 index cases. In a follow-on from the same study, it was estimated that the incremental cost effectiveness ratio (ICER) for FAMCAT2 versus no active screening was £7,552 [ 37 ].…”

Section: Methodsmentioning

confidence: 99%

A comparison of the Netherlands, Norway and UK familial hypercholesterolemia screening programmes with implications for target setting and the UK’s NHS long term plan

Page

Zheng

Wang

et al. 2023

PLOS Glob Public Health

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We sought to determine the most efficacious and cost-effective strategy to follow when developing a national screening programme by comparing and contrasting the national screening programmes of Norway, the Netherlands and the UK. Comparing the detection rates and screening profiles between the Netherlands, Norway, the UK and constituent nations (England, Northern Ireland, Scotland and Wales) it is clear that maximising the number of relatives screened per index case leads to identification of the greatest proportion of an FH population. The UK has stated targets to detect 25% of the population of England with FH across the 5 years to 2024 with the NHS Long Term Plan. However, this is grossly unrealistic and, based on pre-pandemic rates, will only be reached in the year 2096. We also modelled the efficacy and cost-effectiveness of two screening strategies: 1) Universal screening of 1-2-year-olds, 2) electronic healthcare record screening, in both cases coupled to reverse cascade screening. We found that index case detection from electronic healthcare records was 56% more efficacious than universal screening and, depending on the cascade screening rate of success, 36%-43% more cost-effective per FH case detected. The UK is currently trialling universal screening of 1–2-year-olds to contribute to national FH detection targets. Our modelling suggests that this is not the most efficacious or cost-effective strategy to follow. For countries looking to develop national FH programmes, screening of electronic healthcare records, coupled to successful cascade screening to blood relatives is likely to be a preferable strategy to follow.

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“…We estimate that screening of all eligible adult healthcare records in this age-bracket would yield 24,564 index cases. In a followon from the same study, it was estimated that the incremental cost effectiveness ratio (ICER) for FAMCAT2 versus no active screening was £7,552 [37].…”

Section: Screening Programme Comparisonsmentioning

confidence: 99%

A comparison of the Netherlands, Norway and UK Familial Hypercholesterolemia screening programmes with implications for target setting and the UK’s NHS Long Term Plan

Page

Zheng

Wang

et al. 2023

Preprint

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Aims. We sought to determine the most efficacious and cost effective strategy to follow when developing a national screening programme by comparing and contrasting the national screening programmes of Norway, the Netherlands and the UK. Methods and results. Comparing the detection rates and screening profiles between the Netherlands, Norway, the UK and constituent nations (England, Northern Ireland, Scotland and Wales) it is clear that maximising the number of relatives screened per index case leads to identification of the greatest proportion of an FH population. The UK has stated targets to detect 25% of the FH population of England across the 5 years to 2024 with the NHS Long Term Plan. However, this is grossly unrealistic and, based on prepandemic rates, will only be reached in the year 2098. We also modelled the efficacy and costeffectiveness of two screening strategies: 1) Universal screening of 1 to 2 year olds, 2) electronic healthcare record screening, in both cases coupled to reverse cascade screening. We found that index case detection from electronic healthcare records was 56% more efficacious than universal screening and, depending on the cascade screening rate of success, 36% to 43% more cost effective per FH case detected. Conclusion. The UK is currently trialling universal screening of 1 to 2 year olds to contribute to national FH detection targets. Our modelling suggests that this is not the most efficacious or cost effective strategy to follow. For countries looking to develop national FH programmes, screening of electronic healthcare records, coupled to successful cascade screening to blood relatives is likely to be a preferable strategy to follow.

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Cost-Effectiveness of Screening Algorithms for Familial Hypercholesterolaemia in Primary Care

Cited by 9 publications

References 30 publications

Cost-Effectiveness of Screening Strategies for Familial Hypercholesterolaemia: An Updated Systematic Review

Cost-Effectiveness of Screening Strategies for Familial Hypercholesterolaemia: An Updated Systematic Review

A comparison of the Netherlands, Norway and UK familial hypercholesterolemia screening programmes with implications for target setting and the UK’s NHS long term plan

A comparison of the Netherlands, Norway and UK Familial Hypercholesterolemia screening programmes with implications for target setting and the UK’s NHS Long Term Plan

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