Marquina, Clara, Morton, Jedidiah, Brett, Tom, Lloyd, Melanie, Radford, Jan, Heal, Clare, Hespe, Charlotte, Gill, Gerard, Sullivan, David, Zomer, Ella, Li, Ian, Pang, Jing, Watts, Gerald F., and Ademi, Zanfina (2023) Enhancing the Detection and Care of Heterozygous Familial Hypercholesterolemia in Primary Care: Cost-Effectiveness and Return on Investment. Circulation: Genomic and Precision Medicine, 16. e003842. pp. 267-274.

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Abstract

Background: Heterozygous familial hypercholesterolemia (HeFH) is under-detected and undertreated. A general practitioner-led screening and care program for HeFH effectively identified and managed patients with HeFH. We evaluated the cost-effectiveness and the return on investment of an enhanced-care strategy for HeFH in primary care in Australia.

Methods: We developed a multistate Markov model to estimate the outcomes and costs of a general practitioner-led detection and management strategy for HeFH in primary care compared with the standard of care in Australia. The population comprised individuals aged 50 to 80 years, of which 44% had prior cardiovascular disease. Cardiovascular risk, HeFH prevalence, treatment effects, and acute and chronic health care costs were derived from published sources. The study involved screening for HeFH using a validated data-extraction tool (TARB-Ex), followed by a consultation to improve care. The detection rate of HeFH was 16%, and 74% of the patients achieved target LDL-C (low-density lipoprotein cholesterol). Quality-adjusted life years, health care costs, productivity losses, incremental cost-effectiveness ratio, and return on investment ratio were evaluated, outcomes discounted by 5% annually, adopting a health care and a societal perspective.

Results: Over the lifetime horizon, the model estimated a gain of 870 years of life lived and 1033 quality-adjusted life years when the general practitioner-led program was employed compared with standard of care. This resulted in an incremental cost-effectiveness ratio of AU$14 664/quality-adjusted life year gained from a health care perspective. From a societal perspective, this strategy, compared with standard of care was cost-saving, with a return on investment of AU$5.64 per dollar invested.

Conclusions: An enhanced general practitioner-led model of care for HeFH is likely to be cost-effective.

Item ID:	79215
Item Type:	Article (Research - C1)
ISSN:	2574-8300
Copyright Information:	© 2023 American Heart Association, Inc.
Funders:	National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants:	NHMRC GNT 1142885
Date Deposited:	06 Jul 2023 00:35
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 30% 42 HEALTH SCIENCES > 4206 Public health > 420605 Preventative health care @ 70%
SEO Codes:	20 HEALTH > 2004 Public health (excl. specific population health) > 200412 Preventive medicine @ 50% 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
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