The cost-effectiveness of screening strategies for familial hypercholesterolaemia in Poland.

BACKGROUND AND AIMS: Familial hypercholesterolaemia (FH) elevates the cholesterol level and increases the risk of coronary events and death. Early detection and treatment reduce this risk. We aimed to determine the cost-effectiveness of FH screening in Poland in children, first job takers, and after an acute coronary syndrome (ACS) event, each followed by a cascade screening in the relatives of the positively-diagnosed subjects. METHODS: A decision tree was constructed to model the diagnosis process. We considered scenarios with and without genetic testing. A life-time Markov was built to investigate the effectiveness (life years gained, LYG; and quality-adjusted life years, QALY) and cost (public payer perspective) of treatment in FH-affected subjects. The clinical benefits result from early treatment reducing the risk of coronary heart disease (and death, in result). Model parameters were based on published data and experts' opinions. The costs (patients visits, tests, drugs) were estimated from the National Health Fund data and other publicly-available sources. RESULTS: Screening ACS patients below 55/65 years of age in men/women is the most cost-effective strategy: the cost of one LYG (QALY) amounts to 100 EUR (110 EUR). Removing the age limit or using genetic tests reduced cost-effectiveness; nonetheless, all strategies remained cost effective: the cost of one LYG or QALY was <5040 EUR, much lower than the official threshold of ca. 29,800 EUR/QALY. CONCLUSIONS: Screening for FH is highly cost-effective in Poland. The strategies are complementary, and using a combination thereof is recommended.

The influence of particulate matter on respiratory morbidity and mortality in children and infants.

Air pollution is the most important environmental health risk leading to premature mortality, respiratory and other health problems. The aim of this study was to quantify its impact on infants and children in Warsaw (Poland), following the principles of Health Impact Assessment method. Particulate matter (PM(2.5) and PM(10)) was considered as the indicator of air pollution. Exposure-response functions between air pollution and health impacts were employed based on the literature. According to the calculations, around 5,201 asthma symptoms and 234 hospital respiratory admissions were caused annually due to air pollution. Hospitalizations due to cardiovascular problems related to air pollution amounted to 13. The mortality among infants and children is relatively low and occurs mostly in the postneonatal period. Nonetheless, approx. 5 mortality cases were assessed to be air pollution-attributable. The study demonstrates a significant impact of air pollution on infants and children, which is manifested primarily as a range of respiratory problems.

Cost-effectiveness versus Cost-Utility Analyses: What Are the Motives Behind Using Each and How Do Their Results Differ?-A Polish Example.

OBJECTIVES: We aimed to compare the use of cost-effectiveness analysis and cost-utility analysis in health technology assessment in Poland. METHODS: We analyzed all the submissions (155) made to the Polish Agency for Health Technology Assessment in the period 2007 to 2011, with 316 intervention-comparator comparisons reporting incremental cost-effectiveness ratios (ICERs) or incremental cost-utility ratios (ICURs). We compared ICERs and ICURs when both were reported (31%), determined factors associated with reporting one or the other, and tested the precision of their assessment. RESULTS: In 13% of the cases, ICER and ICUR led to different decisions (were on opposite sides of the willingness-to-pay threshold). Cost-effectiveness analyses were more frequently performed in oncology, offering at the same time more favorable results. It was also more frequent for longer time-horizon models, although then ICER values were on average higher. CONCLUSIONS: In Poland, cost-utility analysis is a usual approach of increasing popularity. Interestingly, although assessing ICUR requires additional assumptions, it is estimated more precisely (reported ranges of values in sensitivity analyses are narrower), especially in oncology. ICER and ICUR disagree more often than previously shown in literature. There seem to be no clear signs of biases in submissions (selecting whether to present ICER or ICUR on the basis of their values), but the current study is limited because only the values presented by manufacturers in the submission are available.