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Universal screening at age 1–2 years as an adjunct to cascade testing for familial hypercholesterolaemia in the UK: A cost-utility analysis

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Title: Universal screening at age 1–2 years as an adjunct to cascade testing for familial hypercholesterolaemia in the UK: A cost-utility analysis
Authors: McKay, AJ
Hogan, H
Humphries, S
Marks, D
Ray, K
Miners, A
Item Type: Journal Article
Abstract: Background and aims: Familial hypercholesterolaemia (FH) is widely underdiagnosed. Cascade testing (CT) of relatives has been shown to be feasible, acceptable and cost-effective in the UK, but requires a supply of index cases. Feasibility of universal screening (US) at age 1–2 years was recently demonstrated. We examined whether this would be a cost-effective adjunct to CT in the UK, given the current and plausible future undiagnosed FH prevalence. Methods: Seven cholesterol and/or mutation-based US ± reverse cascade testing (RCT) alternatives were compared with no US in an incremental analysis with a healthcare perspective. A decision model was used to estimate costs and outcomes for cohorts exposed to the US component of each strategy. RCT case ascertainment was modelled using recent UK CT data, and probabilistic Markov models estimated lifetime costs and health outcomes for the cohorts screened under each alternative. 1000 Monte Carlo simulations were run for each model, and average outcomes reported. Further uncertainty was explored deterministically. Threshold analysis investigated the association between undiagnosed FH prevalence and cost-effectiveness. Results: A strategy involving cholesterol screening followed by diagnostic genetic testing and RCT was the most cost-effective modelled (incremental cost-effectiveness ratio (ICER) versus no US £12,480/quality adjusted life year (QALY); probability of cost-effectiveness 96·8% at £20,000/QALY threshold). Cost-effectiveness was robust to both deterministic sensitivity analyses and threshold analyses that modelled ongoing case ascertainment at theoretical maximum levels. Conclusions: These findings support implementation of universal cholesterol screening followed by diagnostic genetic testing and RCT for FH, under a UK conventional willingness-to-pay threshold.
Issue Date: Aug-2018
Date of Acceptance: 30-May-2018
URI: http://hdl.handle.net/10044/1/60465
DOI: https://doi.org/10.1016/j.atherosclerosis.2018.05.047
ISSN: 0021-9150
Publisher: Elsevier
Start Page: 434
End Page: 443
Journal / Book Title: Atherosclerosis
Volume: 275
Copyright Statement: © 2018 Elsevier B.V. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Hyperlipoproteinaemia type II
Systematic population screening
Cost-effectiveness
CORONARY-ARTERY-DISEASE
HEART-DISEASE
CARDIOVASCULAR RISK
CLINICAL-DIAGNOSIS
DIABETES-MELLITUS
STATIN THERAPY
FOLLOW-UP
CHOLESTEROL
CHILDREN
POPULATION
Cost-effectiveness
Hyperlipoproteinaemia type II
Systematic population screening
1103 Clinical Sciences
1102 Cardiorespiratory Medicine and Haematology
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2018-06-04
Appears in Collections:School of Public Health