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A Cost-Effectiveness Analysis of Screening Strategies For Familial Hypercholesterolemia

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A study aimed to systematically synthesize the cost-effectiveness of different screening strategies to detect heterozygous familial hypercholesterolemia (FH). The analysis included screening strategies for FH versus the standard care for FH detection. Cost results were adapted to 2022 US dollars to facilitate comparisons between studies using the same screening strategies. Cost-effectiveness thresholds were based on the original study criteria.

The review included a total of 21 studies evaluating 62 strategies. Most of the studies adopted a healthcare perspective in the base case and were set in high-income countries. The strategies analyzed included cascade screening, opportunistic screening, systematic screening, and population-wide screening. 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 the best next alternative.

Cost-Effectiveness

Cost-Effectiveness of FH Screening Strategies: Cascade Screening Leads with Strong Results

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, opportunistic screening in 85%, systematic screening in 80%, and population-wide screening in 60%. The most common driver of incremental cost-effectiveness ratios identified in the sensitivity analysis was the long-term cost of lipid-lowering treatment.

Based on reported willingness to pay thresholds for each setting, most cost-effective analysis 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.

 

Orijinal Article DOI: 10.1007/s40273-023-01347-7

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

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