Cost effectiveness of case-finding strategies for drug treatment in primary prevention of cardiovascular disease: a modelling study

Abstract

Background: Policies of active case finding for cardiovascular disease (CVD) prevention in healthy adults are common, but economic evaluation has not investigated targeting such strategies at those who are most likely to benefit. Aim: To assess the cost effectiveness of targeted case finding for CVD prevention. Design and setting: Cost-effectiveness modelling in an English primary care population. Method: A cohort of 10 000 individuals aged 30–74 years and without existing CVD or diabetes was sampled from The Health Improvement Network database, a large primary care database. A discrete event simulation was used to model the process of inviting people for assessment, assessing cardiovascular risk, and initiation and persistence with drug treatment. Risk factors and drug cessation rates were obtained from primary care data. Published sources provided estimates of uptake of assessment, treatment initiation, and treatment effects. The researchers determined the lifetime costs and quality adjusted life years (QALYs) with opportunistic case finding and strategies prioritising and targeting patients by age or prior estimate of cardiovascular risk. This study reports on the optimum strategy if a QALY is valued at £20 000. Results: Compared with no case finding, inviting all adults aged 30–74 years in a population of 10 000 yields 30.32 QALYs at a total cost of £705 732. The optimum strategy is to rank patients by prior risk estimate and invite 8% of those who are assessed as being at highest risk (those at ≥12.8% predicted 10-year CVD risk), yielding 17.53 QALYs at a cost of £162 280. There is an 89.4% probability that the optimum strategy is to invite <35% of patients for assessment. Conclusion: Across all age ranges, targeted case finding using a prior estimate of CVD risk is more efficient than universal case finding in healthy adults.