Nherera, L., Marks, D., Minhas, Rubin, Thorogood, Margaret and Humphries, Steve E.. (2011) Probabilistic cost-effectiveness analysis of cascade screening for familial hypercholesterolaemia using alternative diagnostic and identification strategies. Heart, Vol.97 (No.1175). e1181. ISSN 1355-6037

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Abstract

Objective To estimate the probabilistic cost-effectiveness of cascade screening methods in familial hypercholesterolaemia (FH) from the UK NHS perspective. Design Economic evaluation (cost utility analysis) comparing four cascade screening strategies for FH: Using low-density lipoprotein (LDL) cholesterol measurements to diagnose affected relatives (cholesterol method); cascading only in patients with a causative mutation identified and using DNA tests to diagnose relatives (DNA method); DNA testing combined with LDL-cholesterol testing in families with no mutation identified, only in patients with clinically defined ‘definite’ FH (DNA+DFH method); DNA testing combined with LDL-cholesterol testing in no-mutation families of both ‘definite’ and ‘probable’ FH patients (DNA+DFH+PFH). A probabilistic model was constructed to estimate the treatment benefit from statins, with all diagnosed individuals receiving high-intensity statin treatment. Population A cohort of 1000 people suspected of having FH aged 50 years for index cases and 30 years for relatives, followed for a lifetime. Main outcomes Costs, quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER). Results The DNA+DFH+PFH method was the most cost-effective cascade screening strategy. The ICER was estimated at £3666/QALY. Using this strategy, of the tested relatives 30.6% will be true positives, 6.3% false positives, 61.9% true negatives and 1.1% false negatives. Probabilistic sensitivity analysis showed that this approach is 100% cost-effective using the conventional benchmark for cost-effective treatments in the NHS of between £20 000 and £30 000 per QALY gained. Conclusion Cascade testing of relatives of patients with DFH and PFH is cost-effective when using a combination of DNA testing for known family mutations and LDL-cholesterol levels in the remaining families. The approach is more cost-effective than current primary prevention screening strategies.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical screening -- Cost effectiveness, Hypercholesteremia -- Diagnosis -- Cost effectiveness, Hypercholesteremia -- Diagnosis -- Evaluation
Journal or Publication Title:	Heart
Publisher:	B M J Group
ISSN:	1355-6037
Date:	2011
Volume:	Vol.97
Number:	No.1175
Page Range:	e1181
Identification Number:	10.1136/hrt.2010.213975
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	National Collaborating Centre for Primary Care (Great Britain) (NCCPC), National Institute for Health and Clinical Excellence (Great Britain) (NICE)
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URI:	http://wrap.warwick.ac.uk/id/eprint/37442

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