Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To evaluate the cost-effectiveness of using a web-based self-assessment tool to detect cases of Hypercholesterolaemia and subsequently treat with statin therapy.
Methods: Data was collected from 25,364 users of the HeartAware risk factor self-assessment tool administered through a nationwide network of 127 hospitals and clinics. The web-based tool asked participants to report several risks factors for heart disease including: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, diabetes and smoking status, medical history, and family history of disease. Responses enabled the calculation of heart disease risk. Participants identified as high risk were eligible for selection by hospitals or clinics for no-cost clinical screening of the same risk factors. Participants with no history of heart disease and those with both self-reported and clinically measured risk factors were included in the analytic sample. A decision-tree determined if sample members would qualify for statin therapy based on inter-rater agreement of self-reported and clinical measures, prior usage of cholesterol lowering medications, and clinical guidelines for statin therapy established by the Adult Treatment Panel III. HeartAware screening costs were measured along with costs of follow-up testing and treatment for those identified for statin therapy. Cost avoidance associated with reduced risk of heart disease was calculated. Life years gained (LYG) as a result of statin therapy was used to calculate cost per LYG. Sensitivity analysis was also performed for scenarios of low statin adherence and enhanced screening methodologies. Findings were compared to prior studies of cost-effectiveness for opportunistic and universal familial hypercholesterolaemia screening as well as accepted thresholds for cost per LYG.
Results: The analytic sample contained 5,884 participants, with 225 eligible for statin therapy. HeartAware resulted in a cost per LYG of $16,665. Sensitivity analysis for 50% statin adherence resulted in a cost per LYG of $16,428, while enhanced screening methodologies indicated a cost per LYG between $7,620 and $14,607.
Conclusion: Prior studies of opportunistic and universal screening indicate a cost per LYG of $20,313 and $23,413 respectively. Accepted thresholds for cost per LYG are between $35,000 and $60,000. HeartAware is more cost effective than these established screening methodologies, and also favorable relative to accepted willingness to pay thresholds. As such, it should be considered a viable alternative screening method for heart disease.