Lauren E. Hendy PhD , Lisa P. Spees PhD , Casey Tak PhD , Delesha M. Carpenter PhD, MSPH , Kathleen C. Thomas PhD, MPH , Megan C. Roberts PhD
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Abstract
BACKGROUND
Widespread familial hypercholesterolemia screening requires a large upfront economic investment, but the health benefits and cost savings of cardiovascular disease prevention directed by screening occur over many years.
OBJECTIVE
We evaluated the cost-effectiveness of population genetic screening for familial hypercholesterolemia compared to cascade testing to US payers while accounting for patient insurance switching between commercial and Medicare insurance.
METHODS
We developed a hybrid decision-tree Markov model to assess genetic screening in 20-year-old adults over a lifetime horizon in which cohort members transitioned between commercial payers representing 3 commercial plans and Medicare. Health state and coverage transition probabilities, utilities, and event costs were primarily sourced from published literature. We estimated incremental cost-effectiveness ratios per quality-adjusted life year gained and conducted probabilistic and 1-way sensitivity analyses to explore parameters.
RESULTS
Population genetic screening cost an additional $1,024,126, $495,909, and $479,170 per quality-adjusted life year gained for the high, medium, and low benefit commercial payers. Medicare experienced both cost savings and greater quality-adjusted life years in its members under population genetic screening.
CONCLUSIONS
Insurance switching substantially affects the cost-effectiveness of population genetic screening for familial hypercholesterolemia to US payers. Future research examining screening and treatments for other rare diseases that require high investment early in life for downstream health benefits should consider the impact of insurance switching in the US.
期刊介绍：
Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner.
Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.
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