Cost effectiveness of screening for familial high cholesterol

Screening relatives of people with high cholesterol levels is the most cost effective way to reduce deaths from coronary heart disease, yet no recommended screening strategy currently exists in the United Kingdom, according to researchers in this week's British Medical Journal.

High cholesterol that runs in families is known as familial hypercholesterolaemia. About 110,000 people in the U.K. are thought to have the condition, and at least 75 percent of them are undiagnosed. Without identification and treatment, over half of these people will have a fatal or non-fatal coronary heart disease event by age 50 (men) or 60 (women).

Researchers calculated cost effectiveness as cost per life year gained – extension of life expectancy resulting from intervention – including estimated costs of screening and treatment with statin drugs. The screening techniques evaluated were taking family histories from patients, clinical confirmation of high cholesterol levels via blood tests and genetic analysis to uncover a mutant gene. They concluded that:

Universal population screening is least cost effective at $18,892 per life year gained, since 1,365 individuals need to be screened for a cost of $14,130 per case detected.

Tracing of family members through medical histories is the most cost effective strategy at $4,479 per life year gained, as only 2.6 individuals need to be screened to identify one case at a cost of $192 per case detected.

And population screening of 16-year-olds only is about 90 percent as cost effective as family tracing, at $4,027 per life year gained, with a clinical confirmation.

For each strategy, it is more cost effective to screen younger people and women, because the life years gained are higher (see table http://bmj.com/cgi/content-nw/full/324/7349/1303/T2).

Source: Dalya Marks et al., Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia, British Medical Journal, June 1, 2002.

For text http://bmj.com/cgi/content/full/324/7349/1303
For more on Preventive Medicine http://www.ncpa.org/iss/hea

FMF Policy Bulletin\11 June 2002