General practitioner-led HeFH screening, care may be cost-effective vs. standard care
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Key takeaways:
- A general practitioner-led program for genetic high cholesterol treatment was projected to be cost-effective vs. standard care.
- Researchers estimated a return on investment of AU$5.64 per every AU$1 invested.
An Australian general practitioner-led screening and care program for heterozygous familial hypercholesterolemia was projected to be cost-effective with significant return on investment vs. standard care, researchers reported.
It was estimated that less than 10% of Australians living with heterozygous familial hypercholesterolemia (HeFH) have been identified, despite clinical guidance for screening, according to a study published in Circulation: Genomic and Precision Medicine.
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“[General practitioners] are in an optimal position to detect and manage HeFH. Although current guidelines emphasize the role of primary care-based screening and management of HeFH, insufficient attention is given to such approaches,” Clara Marquina, PhD, research fellow in the school of public health and preventive medicine and the center for medicine use and safety at Monash University in Melbourne, Australia, and colleagues wrote. “Although Australia recently approved the reimbursement of cascade genetic screening for HeFH, reimbursement is only available to those who meet relatively strict criteria ... We aimed to evaluate the cost-effectiveness and return on investment of the aforementioned detection and management strategy for HeFH in Australian primary care.”
With a cohort of nearly 30,000 Australian individuals aged 50 to 80 years (44% with prior CVD), Marquina and colleagues developed a multistate Markov model to estimate the outcomes and cost-effectiveness of a general practitioner-led screening and management strategy for HeFH compared with standard care. HeFH was screened using a data-extraction tool (TARB-Ex). In cases of positive HeFH detection, patients were suggested to attend a follow-up consultation to improve care.
Within this cohort, HeFH was detected in 16% of participants, of whom 74% achieved target LDL level.
The researchers reported that over the lifetime, the model estimated a gain of 870 years of life lived and additional 1,033 quality-adjusted life years (QALYs) with use of the general practitioner-led program for HeFH detection and care compared with standard care.
With a willingness-to-pay threshold of AU$28,000 per QALY, Marquina and colleagues observed an incremental cost-effectiveness ratio of AU$14,664 per QALY gained, according to the study.
Compared with standard care, the researchers estimated that the general practitioner-led program for HeFH detection was cost-saving, with a return on investment of AU$5.64 per AU$1 invested.
“This is the first study to model a [general practitioner]-led screening and management program in Australia over a lifetime horizon. We show the cost-effectiveness of alternative screening and treatment strategies for HeFH,” the researchers wrote. “The results of the present study extend these findings to a [general practitioner]-led enhanced-care program. These are likely to complement other methods that target either young adults (ie, genetic screening) or expected to miss a substantial proportion of people with HeFH (ie, cascade screening) by targeting predominantly older adults that remain undiagnosed and at high risk of CHD or have established disease.”
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