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Cost-effectiveness of a cascade screening program for the early detection of familial hypercholesterolemia.
Lázaro, Pablo; Pérez de Isla, Leopoldo; Watts, Gerald F; Alonso, Rodrigo; Norman, Richard; Muñiz, Ovidio; Fuentes, Francisco; Mata, Nelva; López-Miranda, José; González-Juanatey, José Ramón; Díaz-Díaz, José Luis; Blasco, Antonio Javier; Mata, Pedro.
Afiliación
  • Lázaro P; Health Services Researcher, Madrid, Spain. Electronic address: plazaro@gmx.es.
  • Pérez de Isla L; Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain.
  • Watts GF; Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
  • Alonso R; Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Nutrition, Clínica Las Condes, Santiago de Chile, Chile.
  • Norman R; Department of Health Policy and Management, School of Public Health, Curtin University, Western Australia, Australia.
  • Muñiz O; Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain.
  • Fuentes F; Department of Internal Medicine, IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Cordoba, Spain.
  • Mata N; Fundación Hipercolesterolemia Familiar, Madrid, Spain; Department of Epidemiology, Madrid Health Authority, Madrid, Spain.
  • López-Miranda J; Department of Internal Medicine, IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain.
  • González-Juanatey JR; Department of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Spain.
  • Díaz-Díaz JL; Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain.
  • Blasco AJ; Health Services Researcher, Madrid, Spain.
  • Mata P; Fundación Hipercolesterolemia Familiar, Madrid, Spain.
J Clin Lipidol ; 11(1): 260-271, 2017.
Article en En | MEDLINE | ID: mdl-28391894
BACKGROUND: Although familial hypercholesterolemia (FH) confers a high risk of coronary artery disease, most patients are undiagnosed, and little is known about the efficiency of genetic cascade screening programs at national level. OBJECTIVE: The aim of the study was to estimate the cost-effectiveness of a national genetic cascade screening program in Spain. METHODS: An economic evaluation was performed using a decision tree analysis. The choice in the decision tree was between implementation of the national program for FH (NPFH) or keeping the usual clinical care. The NPFH detects FH patients through total cholesterol measurement at primary care level and use of genetic testing in index cases and relatives. The payer (National Health System) and social (including the productivity lost) perspectives were considered. The outcome variables were coronary events avoided, deaths avoided, and quality-adjusted life years (QALYs) gained. RESULTS: From the payer perspective, the application of the NPFH during 1 year prevents 847 coronary events and 203 deaths in the 9000 FH patients cohort during a 10-year follow-up, yielding an extra 767 QALYs, at a cost of €29,608 per QALY gained. From the social perspective, the NPFH is dominant over the control (the cost decreases and the effectiveness increases). The sensitivity analysis confirms the robustness of the findings. CONCLUSION: The NPFH based on molecular testing is a cost-effective diagnostic and management strategy that supports government expenditure aimed at preventing coronary artery disease in FH patients in Spain. Implementation of such a strategy is likely to be also cost-effective in countries with similar developed healthcare systems.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tamizaje Masivo / Análisis Costo-Beneficio / Hiperlipoproteinemia Tipo II Tipo de estudio: Diagnostic_studies / Evaluation_studies / Health_economic_evaluation / Prognostic_studies / Screening_studies Aspecto: Patient_preference Límite: Adult / Female / Humans / Male Idioma: En Revista: J Clin Lipidol Asunto de la revista: BIOQUIMICA / METABOLISMO Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tamizaje Masivo / Análisis Costo-Beneficio / Hiperlipoproteinemia Tipo II Tipo de estudio: Diagnostic_studies / Evaluation_studies / Health_economic_evaluation / Prognostic_studies / Screening_studies Aspecto: Patient_preference Límite: Adult / Female / Humans / Male Idioma: En Revista: J Clin Lipidol Asunto de la revista: BIOQUIMICA / METABOLISMO Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos