Pablo Lázaro1, Leopoldo Pérez de Isla2, Gerald F Watts3, Rodrigo Alonso4, Richard Norman5, Ovidio Muñiz6, Francisco Fuentes7, Nelva Mata8, José López-Miranda9, José Ramón González-Juanatey10, José Luis Díaz-Díaz11, Antonio Javier Blasco12, Pedro Mata13. 1. Health Services Researcher, Madrid, Spain. Electronic address: plazaro@gmx.es. 2. Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain. 3. Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. 4. Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Nutrition, Clínica Las Condes, Santiago de Chile, Chile. 5. Department of Health Policy and Management, School of Public Health, Curtin University, Western Australia, Australia. 6. Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain. 7. Department of Internal Medicine, IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Cordoba, Spain. 8. Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Epidemiology, Madrid Health Authority, Madrid, Spain. 9. Department of Internal Medicine, IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain. 10. Department of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Spain. 11. Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain. 12. Health Services Researcher, Madrid, Spain. 13. Fundación Hipercolesterolemia Familiar, Madrid, Spain.
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.
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 FHpatients 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 FHpatients 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 FHpatients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.
Authors: Karl Johnson; Katherine W Saylor; Isabella Guynn; Karen Hicklin; Jonathan S Berg; Kristen Hassmiller Lich Journal: Genet Med Date: 2021-12-07 Impact factor: 8.822
Authors: Katrina L Ellis; Jing Pang; David Chieng; Damon A Bell; John R Burnett; Carl J Schultz; Graham S Hillis; Gerald F Watts Journal: Clin Cardiol Date: 2018-02-26 Impact factor: 2.882
Authors: Gerald F Watts; Samuel S Gidding; Pedro Mata; Jing Pang; David R Sullivan; Shizuya Yamashita; Frederick J Raal; Raul D Santos; Kausik K Ray Journal: Nat Rev Cardiol Date: 2020-01-23 Impact factor: 32.419
Authors: Kelly D Myers; Joshua W Knowles; David Staszak; Michael D Shapiro; William Howard; Mrinal Yadava; David Zuzick; Latoya Williamson; Nigam H Shah; Juan M Banda; Joe Leader; William C Cromwell; Ed Trautman; Michael F Murray; Seth J Baum; Seth Myers; Samuel S Gidding; Katherine Wilemon; Daniel J Rader Journal: Lancet Digit Health Date: 2019-10-21
Authors: Sukh Makhnoon; Grace Tran; Brooke Levin; Kristin D Mattie; Brian Dreyer; Robert J Volk; Generosa Grana; Banu K Arun; Susan K Peterson Journal: Cancer Date: 2021-06-22 Impact factor: 6.860