Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense 5000, Denmark.
Department of Cardiology, Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense 5000, Denmark.
Eur Heart J. 2022 Nov 1;43(41):4392-4402. doi: 10.1093/eurheartj/ehac488.
A recent trial has shown that screening of men for cardiovascular disease (CVD) may reduce all-cause mortality. This study assesses the cost effectiveness of such screening vs. no screening from the perspective of European healthcare systems.
Randomized controlled trial-based cost-effectiveness evaluation with a mean 5.7 years of follow-up. Screening was based on low-dose computed tomography to detect coronary artery calcification and aortic/iliac aneurysms, limb blood pressure measurement to detect peripheral artery disease and hypertension, telemetric assessment of the heart rhythm to detect atrial fibrillation, and measurements of the cholesterol and HgbA1c levels. Censoring-adjusted incremental costs, life years (LY), and quality-adjusted LY (QALY) were estimated and used for cost-effectiveness analysis. The incremental cost of screening for the entire health care sector was €207 [95% confidence interval (CI) -24; 438, P = 0.078] per invitee for which gains of 0.019 LY (95% CI -0.007; 0.045, P = 0.145) and 0.023 QALY (95% CI -0.001; 0.046, P = 0.051) were achieved. The corresponding incremental cost-effectiveness ratios were of €10 812 per LY and €9075 per QALY, which would be cost effective at probabilities of 0.73 and 0.83 for a willingness to pay of €20 000. Assessment of population heterogeneity showed that cost effectiveness could be more attractive for younger men without CVD at baseline.
Comprehensive screening for CVD is overall cost effective at conventional thresholds for willingness to pay and also competitive to the cost effectiveness of common cancer screening programmes. The screening target group, however, needs to be settled.
最近的一项试验表明，对男性进行心血管疾病（CVD）筛查可能会降低全因死亡率。本研究从欧洲医疗保健系统的角度评估了这种筛查与不筛查的成本效益。
基于随机对照试验的成本效益评估，平均随访时间为 5.7 年。筛查基于低剂量计算机断层扫描（CT）检测冠状动脉钙化和主动脉/髂动脉瘤、肢体血压测量检测外周动脉疾病和高血压、遥测心电图评估心律失常检测心房颤动，以及胆固醇和 HgbA1c 水平的测量。估计了校正后的增量成本、生命年（LY）和校正后的质量调整生命年（QALY），并用于成本效益分析。整个医疗保健部门的筛查增量成本为每位受邀者 207 欧元（95%置信区间 [CI] -24；438，P = 0.078），可获得 0.019 LY（95% CI -0.007；0.045，P = 0.145）和 0.023 QALY（95% CI -0.001；0.046，P = 0.051）的增益。相应的增量成本效益比为每 LY 10812 欧元和每 QALY 9075 欧元，如果支付意愿为 20000 欧元，其概率分别为 0.73 和 0.83，则具有成本效益。对人群异质性的评估表明，在常规支付意愿阈值下，综合 CVD 筛查总体上具有成本效益，并且与常见癌症筛查计划的成本效益相当。然而，需要确定筛查目标人群。
在常规支付意愿阈值下，综合 CVD 筛查总体上具有成本效益，并且与常见癌症筛查计划的成本效益相当。然而，需要确定筛查目标人群。
