PDF(Pubmed)
Abstract：
BACKGROUND: OBJECTIVE: This study aimed to systematically synthesise the cost-effectiveness of screening strategies to detect heterozygous familial hypercholesterolemia (FH).
METHODS: We searched seven databases from inception to 2 February , 2023, for eligible cost-effective analysis (CEA) that evaluated screening strategies for FH versus the standard care for FH detection. Independent reviewers performed the screening, data extraction and quality evaluation. Cost results were adapted to 2022 US dollars (US$) to facilitate comparisons between studies using the same screening strategies. Cost-effectiveness thresholds were based on the original study criteria.
RESULTS: A total of 21 studies evaluating 62 strategies were included in this review, most of the studies (95%) adopted a healthcare perspective in the base case, and majority were set in high-income countries. Strategies analysed included cascade screening (23 strategies), opportunistic screening (13 strategies), systematic screening (11 strategies) and population-wide screening (15 strategies). Most of the strategies relied on genetic diagnosis for case ascertainment. The most common comparator was no screening, but some studies compared the proposed strategy versus current screening strategies or versus the best next alternative. Six studies evaluated screening in children while the remaining were targeted at adults. From a healthcare perspective, cascade screening was cost-effective in 78% of the studies [cost-adapted incremental cost-effectiveness ratios (ICERs) ranged from dominant to 2022 US$ 104,877], opportunistic screening in 85% (ICERs from US$4959 to US$41,705), systematic screening in 80% (ICERs from US$2763 to US$69,969) and population-wide screening in 60% (ICERs from US$1484 to US$223,240). The most common driver of ICER identified in the sensitivity analysis was the long-term cost of lipid-lowering treatment.
CONCLUSIONS: Based on reported willingness to pay thresholds for each setting, most CEA studies concluded that screening for FH compared with no screening was cost-effective, regardless of the screening strategy. Cascade screening resulted in the largest health benefits per person tested.
METHODS: We searched seven databases from inception to 2 February , 2023, for eligible cost-effective analysis (CEA) that evaluated screening strategies for FH versus the standard care for FH detection. Independent reviewers performed the screening, data extraction and quality evaluation. Cost results were adapted to 2022 US dollars (US$) to facilitate comparisons between studies using the same screening strategies. Cost-effectiveness thresholds were based on the original study criteria.
RESULTS: A total of 21 studies evaluating 62 strategies were included in this review, most of the studies (95%) adopted a healthcare perspective in the base case, and majority were set in high-income countries. Strategies analysed included cascade screening (23 strategies), opportunistic screening (13 strategies), systematic screening (11 strategies) and population-wide screening (15 strategies). Most of the strategies relied on genetic diagnosis for case ascertainment. The most common comparator was no screening, but some studies compared the proposed strategy versus current screening strategies or versus the best next alternative. Six studies evaluated screening in children while the remaining were targeted at adults. From a healthcare perspective, cascade screening was cost-effective in 78% of the studies [cost-adapted incremental cost-effectiveness ratios (ICERs) ranged from dominant to 2022 US$ 104,877], opportunistic screening in 85% (ICERs from US$4959 to US$41,705), systematic screening in 80% (ICERs from US$2763 to US$69,969) and population-wide screening in 60% (ICERs from US$1484 to US$223,240). The most common driver of ICER identified in the sensitivity analysis was the long-term cost of lipid-lowering treatment.
CONCLUSIONS: Based on reported willingness to pay thresholds for each setting, most CEA studies concluded that screening for FH compared with no screening was cost-effective, regardless of the screening strategy. Cascade screening resulted in the largest health benefits per person tested.
摘要：
背景：目的：本研究旨在系统地综合检测杂合子家族性高胆固醇血症（FH）的筛查策略的成本效益。
方法：从成立到2月2日，我们搜索了七个数据库，2023年，用于评估FH筛查策略与FH检测标准护理的合格成本效益分析（CEA）。独立审稿人进行了筛选，数据提取和质量评价。成本结果调整为2022美元（US$），以促进使用相同筛查策略的研究之间的比较。成本效益阈值基于原始研究标准。
结果：本综述共纳入21项研究，评估62项策略。大多数研究(95%)在基本情况下采用了医疗保健的观点，大多数是在高收入国家。分析的策略包括级联筛选(23种策略)，机会性筛查(13种策略)，系统筛查(11种策略)和全人群筛查(15种策略)。大多数策略依赖于基因诊断来确定病例。最常见的比较是没有筛查，但一些研究将拟议的筛查策略与当前筛查策略或最佳的下一个替代方案进行了比较.六项研究评估了儿童的筛查，其余研究针对成人。从医疗保健的角度来看,在78%的研究中，级联筛查具有成本效益[成本适应的增量成本效益比(ICER)从主导到2022年104,877美元]，85%的机会性筛查(ICER从4959美元降至41,705美元)，80%的系统筛查(ICER从2763美元到69,969美元)和60%的全人群筛查(ICER从1484美元到223,240美元).在敏感性分析中确定的ICER最常见的驱动因素是降脂治疗的长期成本。
结论：根据报告的每个设置的支付意愿阈值，大多数CEA研究得出的结论是，筛查FH与不筛查相比具有成本效益，无论筛查策略如何。级联筛查产生了最大的人均健康益处。
方法：从成立到2月2日，我们搜索了七个数据库，2023年，用于评估FH筛查策略与FH检测标准护理的合格成本效益分析（CEA）。独立审稿人进行了筛选，数据提取和质量评价。成本结果调整为2022美元（US$），以促进使用相同筛查策略的研究之间的比较。成本效益阈值基于原始研究标准。
结果：本综述共纳入21项研究，评估62项策略。大多数研究(95%)在基本情况下采用了医疗保健的观点，大多数是在高收入国家。分析的策略包括级联筛选(23种策略)，机会性筛查(13种策略)，系统筛查(11种策略)和全人群筛查(15种策略)。大多数策略依赖于基因诊断来确定病例。最常见的比较是没有筛查，但一些研究将拟议的筛查策略与当前筛查策略或最佳的下一个替代方案进行了比较.六项研究评估了儿童的筛查，其余研究针对成人。从医疗保健的角度来看,在78%的研究中，级联筛查具有成本效益[成本适应的增量成本效益比(ICER)从主导到2022年104,877美元]，85%的机会性筛查(ICER从4959美元降至41,705美元)，80%的系统筛查(ICER从2763美元到69,969美元)和60%的全人群筛查(ICER从1484美元到223,240美元).在敏感性分析中确定的ICER最常见的驱动因素是降脂治疗的长期成本。
结论：根据报告的每个设置的支付意愿阈值，大多数CEA研究得出的结论是，筛查FH与不筛查相比具有成本效益，无论筛查策略如何。级联筛查产生了最大的人均健康益处。
