Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia
Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia
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DOI：
10.1136/bmj.324.7349.1303
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发表时间：
2002-06-01
影响因子：
105.7
通讯作者：
Neil, HAW
中科院分区：
文献类型：
--
作者：
Marks, D;Wonderling, D;Neil, HAW
目的评估筛查和治疗家族性高胆固醇血症策略的成本效益。设计成本效益分析。参与者模拟英格兰和威尔士年龄在16-54岁的人群。干预通过普遍筛查、初级保健中的机会性筛查、因过早心肌梗死入院的人的筛查、或追踪受影响患者的家人。主要结果衡量成本效益计算为获得的每生命年成本（干预导致的预期寿命延长）包括筛查和治疗的估计费用。结果追踪家庭成员是最具成本效益的策略（每增加一个生命年3 097英镑（（原文如此）5 066美元，4 479美元）），因为每发现一个病例需要筛查2.6个人，费用为133英镑。如果在家庭中知道基因突变，则通过基因诊断确认，他们每生命年的成本（4 914英镑）仅略有增加。全民筛查的成本效益最低（13 029英镑，生命年增加），因为需要对1 365人进行筛查，每发现一个病例的成本为9 754英镑。对于每一种战略来说，对年轻人和妇女进行筛查更具成本效益。有针对性的战略是更昂贵的每一个人筛选，但每个案件的成本较低。人口筛查16奥尔兹的青少年只有成本效益的家庭tracing（pound 2777与临床确认）。结论筛查家族性高胆固醇血症的人的家庭成员是最具成本效益的选择，在整个人口中检测病例。
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 16-54 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 die most cost effective strategy (pound3097 ((sic)5066, $4479) per life year gained) as 2.6 individuals need to be screened to identify one case at a cost of pound133 per case detected. If the genetic mutation was known within the family their the cost per life year gained (pound4914) was only slightly increased by genetic confirmation of tire diagnosis. Universal population screening was least cost effective (pound13029 pet, life year gained) as 1365 individuals need to be screened at a cost of pound9754 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 (pound2777 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.