Journal of Public Health Medicine 25:47-52 (2003)
© 2003 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
Comparing costs and benefits over a 10 year period of strategies for familial hypercholesterolaemia screening
Dalya Marks
Margaret Thorogood
H. Andrew W. Neil
David Wonderling
Steve E. Humphries
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Infirmary, Oxford OX2 6HE.
Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Royal Free and University College London Medical School, Rayne Building, 5 University Street, London WC1E 6JJ.
Address correspondence to Dr M. Thorogood. E-mail: Margaret.Thorogood@lshtm.ac.uk
Background Approximately 110 000 people in the United Kingdom are affected with familial hypercholesterolaemia (FH). At least 75 per cent are undiagnosed. Treatment with statins is effective but effective primary prevention requires early diagnosis. The best strategy to achieve this is unclear. This paper compares the costs and benefits over a 10 year period of two strategies found in our previous modelling: population screening of 16-year-olds or tracing family members of affected patients.
Methods Computer modelling of time-limited data was conducted. The number available for screening and the potential new cases in England and Wales aged 16–54 years were estimated. The costs (of screening and treatment) and benefits (deaths averted) that might be accrued over 10 years were assessed.
Results Screening 16-year-olds results in 470 new diagnoses, and over 10 subsequent years averts 11.7 deaths at a cost of £6 176 649, giving a cost per case identified and treated of £13 141 (including a 10 year drug cost of £1 584 918). By contrast, screening first-degree relatives of known cases results in 13 248 new diagnoses, 560 deaths averted over 10 years, at a cost of £46 430 681, giving a cost per case identified and treated of £3 505 (including 10 year drug cost of £44 645 760). The cost per death averted would be £3 187.
Conclusions Although the two approaches appear similar in cost-effectiveness over a lifetime, the shorter-term (10 year) cost-effectiveness clearly favours family tracing. This represents good value for money compared with common medical interventions, and suggests that pilot FH family tracing programmes should be conducted.
Keywords: familial hypercholesterolaemia, screening, costs, benefits
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