Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention.

Pubmed ID: 28376458

Pubmed Central ID: PMC5217841

Journal: Annals of family medicine

Publication Date: Jan. 1, 2017

MeSH Terms: Humans, Male, Adult, Female, Aged, Hypercholesterolemia, United States, Adolescent, Middle Aged, Hypertension, Young Adult, Mass Screening, Colorectal Neoplasms, Sex Distribution, Cost-Benefit Analysis, Primary Prevention, Quality-Adjusted Life Years, Counseling, Aspirin, Ethnicity

Grants: H25 PS003610

Authors: Dehmer SP, Maciosek MV, Flottemesch TJ, LaFrance AB

Cite As: Dehmer SP, Maciosek MV, LaFrance AB, Flottemesch TJ. Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention. Ann Fam Med 2017 Jan;15(1):23-36. Epub 2017 Jan 6.

Studies:

Abstract

PURPOSE: Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity. METHODS: We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes are health impact, measured by the net difference in lifetime quality-adjusted life years (QALYs), and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results are also presented for population subgroups defined by sex and race/ethnicity. RESULTS: Health impact is highest for hypertension screening and treatment (15,600 QALYs), but is closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling has a lower health impact (2,200 QALYs) but is found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment is $33,800 per QALY and $48,500 per QALY, respectively. Findings favor hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population. CONCLUSIONS: All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.