Marks, Dalya, Wonderling, David, Thorogood, Margaret, Lambert, Helen, Humphries, Steve E. and Neil, H. A. W. (2002) Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia. BMJ, Vol.324 (No.7349). doi:10.1136/bmj.324.7349.1303

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Abstract

Objectives To assess the cost effectiveness of
strategies to screen for and treat familial
hypercholesterolaemia.
Design Cost effectiveness analysis. A care pathway for
each patient was delineated and the associated
probabilities, benefits, and costs were calculated.
Participants Simulated population aged 16­54 years
in England and Wales.
Interventions Identification and treatment of patients
with familial hypercholesterolaemia by universal
screening, opportunistic screening in primary care,
screening of people admitted to hospital with
premature myocardial infarction, or tracing family
members of affected patients.
Main outcome measure Cost effectiveness calculated
as cost per life year gained (extension of life
expectancy resulting from intervention) including
estimated costs of screening and treatment.
Results Tracing of family members was the most cost
effective strategy (£3097 (&5066, $4479) per life year
gained) as 2.6 individuals need to be screened to
identify one case at a cost of £133 per case detected. If
the genetic mutation was known within the family
then the cost per life year gained (£4914) was only
slightly increased by genetic confirmation of the
diagnosis. Universal population screening was least
cost effective (£13 029 per life year gained) as 1365
individuals need to be screened at a cost of £9754 per
case detected. For each strategy it was more cost
effective to screen younger people and women.
Targeted strategies were more expensive per person
screened, but the cost per case detected was lower.
Population screening of 16 year olds only was as cost
effective as family tracing (£2777 with a clinical
confirmation).
Conclusions Screening family members of people
with familial hypercholesterolaemia is the most cost
effective option for detecting cases across the whole
population.

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):	Hypercholesteremia, Medical screening -- Cost effectiveness
Journal or Publication Title:	BMJ
Publisher:	BMJ Group
ISSN:	0959-535X
Official Date:	1 June 2002
Dates:	Date Event 1 June 2002 Published
Volume:	Vol.324
Number:	No.7349
DOI:	10.1136/bmj.324.7349.1303
Status:	Peer Reviewed
Access rights to Published version:	Restricted or Subscription Access
Funder:	Great Britain. National Health Service (NHS), Merck Sharp & Dohme, British Heart Foundation
Grant number:	95/29/04 (NHS), RG2000025 (BHF), RG93008 (BHF)

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