Cost effectiveness of cascade testing for familial hypercholesterolaemia, based on data from familial hypercholesterolaemia services in the UK
| Autor: | Marion Kerr, Z. Miedzybrodzka, M. Cather, Melanie Watson, Kate Haralambos, Robert Pears, Steve E. Humphries |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Cascade testing Index (economics) Prevention and Epidemiology Adolescent Cost effectiveness Cost-Benefit Analysis Familial hypercholesterolemia 030204 cardiovascular system & hematology Hyperlipoproteinemia Type II 03 medical and health sciences Young Adult 0302 clinical medicine Age Distribution Quality of life Cost of Illness Clinical Research Medicine Humans 030212 general & internal medicine Genetic Testing Child Index case health care economics and organizations Aged Aged 80 and over business.industry Infant Newborn Infant Middle Aged medicine.disease Markov model Coronary heart disease Markov Chains United Kingdom Pedigree Child Preschool Mutation Female Quality-Adjusted Life Years Familial hypercholesterolaemia Cardiology and Cardiovascular Medicine business Incremental cost-effectiveness ratio Demography |
| Zdroj: | European Heart Journal |
| ISSN: | 1522-9645 |
| Popis: | Aims Familial hypercholesterolaemia (FH) is a vastly under-diagnosed genetic disorder, associated with early development of coronary heart disease and premature mortality which can be substantially reduced by effective treatment. Patents have recently expired on high-intensity statins, reducing FH treatment costs. We build a model using UK data to estimate the cost effectiveness of DNA testing of relatives of those with monogenic FH. Methods and Results A Markov model was used to estimate the cost effectiveness of cascade testing, using data from UK cascade services. The estimated incremental cost effectiveness ratio (ICER) was £5806 and the net marginal lifetime cost per relative tested was £2781. More than 80% of lifetime costs were diagnosis-related and incurred in the 1st year. In UK services, 23% of 6396 index cases were mutation-positive. For each mutation-positive index case, 1.33 relatives were tested, resulting overall in a rate of 0.31 tested relatives per tested index case. If the number of relatives tested per tested index case rose to 3.2 (projected by National Institute for Health and Care Excellence in 2008) the ICER would reduce to £2280 and lifetime costs to £1092. Conclusion Cascade testing of relatives of those with suspected FH is highly cost effective. The current Europe-wide high levels of undiagnosed FH, and associated morbidity and mortality, mean adoption of cascade services should yield substantial quality of life and survival gains. |
| Databáze: | OpenAIRE |
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