Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data
Abstract Background While screening for cardiovascular disease (CVD) risk can help low-resource health systems deliver low-cost, effective prevention, evidence is needed to adapt international screening guidelines for maximal impact in local settings. We aimed to establish how the cost-effectiveness...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-023-16640-5 |
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| author | Nilmini Wijemunige Ravindra P. Rannan-Eliya Pieter van Baal Owen O’Donnell |
| author_facet | Nilmini Wijemunige Ravindra P. Rannan-Eliya Pieter van Baal Owen O’Donnell |
| author_sort | Nilmini Wijemunige |
| collection | DOAJ |
| description | Abstract Background While screening for cardiovascular disease (CVD) risk can help low-resource health systems deliver low-cost, effective prevention, evidence is needed to adapt international screening guidelines for maximal impact in local settings. We aimed to establish how the cost-effectiveness of CVD risk screening in Sri Lanka varies with who is screened, how risk is assessed, and what thresholds are used for prescription of medicines. Methods We used data for people aged 35 years and over from a 2018/19 nationally representative survey in Sri Lanka. We modelled the costs and quality adjusted life years (QALYs) for 128 screening program scenarios distinguished by a) age group screened, b) risk tool used, c) definition of high CVD risk, d) blood pressure threshold for treatment of high-risks, and e) prescription of statins to all diabetics. We used the current program as the base case. We used a Markov model of a one-year screening program with a lifetime horizon and a public health system perspective. Results Scenarios that included the WHO-2019 office-based risk tool dominated most others. Switching to this tool and raising the age threshold for screening from 35 to 40 years gave an incremental cost-effectiveness ratio (ICER) of $113/QALY. Lowering the CVD high-risk threshold from 20 to 10% and prescribing antihypertensives at a lower threshold to diabetics and people at high risk of CVD gave an ICER of $1,159/QALY. The findings were sensitive to allowing for disutility of daily medication. Conclusions In Sri Lanka, CVD risk screening scenarios that used the WHO-2019 office-based risk tool, screened people above the age of 40, and lowered risk and blood pressure thresholds would likely be cost-effective, generating an additional QALY at less than half a GDP per capita. |
| first_indexed | 2024-03-09T14:51:16Z |
| format | Article |
| id | doaj.art-60fd38e467b6406a8487a441bd044c20 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-09T14:51:16Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-60fd38e467b6406a8487a441bd044c202023-11-26T14:27:49ZengBMCBMC Public Health1471-24582023-09-0123111310.1186/s12889-023-16640-5Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey dataNilmini Wijemunige0Ravindra P. Rannan-Eliya1Pieter van Baal2Owen O’Donnell3Institute for Health PolicyInstitute for Health PolicyErasmus School of Health Policy & Management, Erasmus University RotterdamErasmus School of Economics and Erasmus School of Health Policy & Management, Erasmus University RotterdamAbstract Background While screening for cardiovascular disease (CVD) risk can help low-resource health systems deliver low-cost, effective prevention, evidence is needed to adapt international screening guidelines for maximal impact in local settings. We aimed to establish how the cost-effectiveness of CVD risk screening in Sri Lanka varies with who is screened, how risk is assessed, and what thresholds are used for prescription of medicines. Methods We used data for people aged 35 years and over from a 2018/19 nationally representative survey in Sri Lanka. We modelled the costs and quality adjusted life years (QALYs) for 128 screening program scenarios distinguished by a) age group screened, b) risk tool used, c) definition of high CVD risk, d) blood pressure threshold for treatment of high-risks, and e) prescription of statins to all diabetics. We used the current program as the base case. We used a Markov model of a one-year screening program with a lifetime horizon and a public health system perspective. Results Scenarios that included the WHO-2019 office-based risk tool dominated most others. Switching to this tool and raising the age threshold for screening from 35 to 40 years gave an incremental cost-effectiveness ratio (ICER) of $113/QALY. Lowering the CVD high-risk threshold from 20 to 10% and prescribing antihypertensives at a lower threshold to diabetics and people at high risk of CVD gave an ICER of $1,159/QALY. The findings were sensitive to allowing for disutility of daily medication. Conclusions In Sri Lanka, CVD risk screening scenarios that used the WHO-2019 office-based risk tool, screened people above the age of 40, and lowered risk and blood pressure thresholds would likely be cost-effective, generating an additional QALY at less than half a GDP per capita.https://doi.org/10.1186/s12889-023-16640-5CVD risk screeningDiabetesCost-effectiveness analysisModelling studyLow-middle incomeSri Lanka |
| spellingShingle | Nilmini Wijemunige Ravindra P. Rannan-Eliya Pieter van Baal Owen O’Donnell Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data BMC Public Health CVD risk screening Diabetes Cost-effectiveness analysis Modelling study Low-middle income Sri Lanka |
| title | Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data |
| title_full | Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data |
| title_fullStr | Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data |
| title_full_unstemmed | Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data |
| title_short | Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data |
| title_sort | optimizing cardiovascular disease risk screening in a low resource setting cost effectiveness of program modifications in sri lanka modelled with nationally representative survey data |
| topic | CVD risk screening Diabetes Cost-effectiveness analysis Modelling study Low-middle income Sri Lanka |
| url | https://doi.org/10.1186/s12889-023-16640-5 |
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