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CVD preventive services beneficial, can be tailored to individual patient

Although screening and treatment for lipid disorders, aspirin counseling for primary prevention of cardiovascular disease and colorectal cancer as well as screening and treatment for hypertension are highly recommended by the U.S. Preventive Services Task Force, individual demographic characteristics and clinical objectives should also be considered, researchers reported in the Annals of Family Medicine.

“This study contributes to a broader evidence base that uses modeling to assess the incremental and comparative effectiveness of clinical services for the primary prevention of [cardiovascular disease (CVD)],” Steven P. Dehmer, PhD, of HealthPartners Institute, Minneapolis, and colleagues wrote. “Direct comparisons are often difficult because of differing research questions and methods. Nevertheless, common threads across these evaluations include the sizable disease prevention potential …”

Dehmer and colleagues used microsimulation modeling to update the economic and health impact of three preventative services recommended by the USPSTF: screening and treatment for lipid disorders (usually high cholesterol); aspirin counseling for the primary prevention of CVD and colorectal cancer; and screening and treatment for hypertension, to the comparative rankings of the National Commission on Prevention Priorities. Results by sex and race were also examined.

According to researchers, health impact was highest for hypertension screening and treatment, at 15,600 quality-adjusted life years (QALYs), with cholesterol screening and treatment close behind (14,300 QALYs). In addition, aspirin counseling had  a lower health impact (2,200 QALYs) but was cost-saving ($3.1 million in net cost savings over the birth cohort’s lifetime). Researchers also reported that though cost savings for both hypertension and cholesterol were each approximately $35 million and covered the cost of screening, managing and treating each of these conditions went over $100 million. In addition, cost-effectiveness for cholesterol screening and treatment was $33,800 per QALY; for hypertension screening and treatment, cost-effectiveness was $48,500 per QALY. Also, opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population, and findings favored hypertension screening over cholesterol screening and treatment for women.

“Our findings also highlight opportunities for closing gaps among populations for which persistent care access and quality disparities have hindered uptake of effective preventive services and advance the case toward a personalized approach to quantitative priority setting,” researchers wrote. “Overall, our findings affirm that aspirin counseling for primary prevention and asymptomatic screening and treatment of hypertension and lipid disorders should remain among the top prevention priorities for adults in primary care.”

Researchers noted the number of deaths from CVD has been cut in half since 1950, with as much as one-half of that success attributable to prevention efforts.

“The case for prevention can sometimes be a challenging one; benefits often accrue far in the future, and costs tend to be highest upfront. Nevertheless, our analysis indicates that clinical services for the primary prevention of CVD can avert substantial disease burden and potentially save costs,” Dehmer and colleagues wrote.  – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.