June 16, 2023Open Access

Health Economic Research Assessing the Value of Early Detection of Cardiovascular Disease: A Systematic Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Cardiovascular disease (n=49). Intervention: Early detection strategies for cardiovascular disease vs. No early detection. Primary outcome: Cost-effectiveness (Incremental Cost-Effectiveness Ratio).

Key Result

Early cardiovascular disease detection strategies were reported as cost-effective in 87.8% (43 of 49) of evaluated strategies compared with no early detection.

Study Design

Type

Systematic Review (n=49)

Structured PICO

Does early detection of cardiovascular disease improve cost-effectiveness in adult populations at risk?

Population

Adult populations at risk of cardiovascular disease without prior CVD diagnosis (49 included articles reporting on 48 unique early detection strategies)

Intervention

Early detection strategies for cardiovascular disease (including screening for risk factors or early diagnosis of CVD in asymptomatic individuals)

Comparator

No early detection or usual care (in 41 out of 49 included studies)

Outcome

Cost-effectiveness (incremental cost-effectiveness ratio, total and incremental costs, and health outcomes such as QALYs)

Early cardiovascular disease detection strategies, particularly for atrial fibrillation, are predominantly cost-effective and may reduce overall CVD-related costs compared to no early detection.

Limitations

Lack of standardization complicates the comparison of cost-effectiveness outcomes between studies.
Real-world cost effectiveness of early CVD detection strategies will depend on the target country and local context.
Potential publication bias, as studies with a negative outcome may be published less often.
Reporting quality was considered high in only one health economic evaluation.
Markov cohort state transition models were frequently used but may not be the most suitable to simulate the long-term impact of early detection strategies.

Abstract

INTRODUCTION: Cardiovascular disease (CVD) is the most prominent cause of death worldwide and has a major impact on healthcare budgets. While early detection strategies may reduce the overall CVD burden through earlier treatment, it is unclear which strategies are (most) efficient. AIM: This systematic review reports on the cost effectiveness of recent early detection strategies for CVD in adult populations at risk. METHODS: PubMed and Scopus were searched to identify scientific articles published between January 2016 and May 2022. The first reviewer screened all articles, a second reviewer independently assessed a random 10% sample of the articles for validation. Discrepancies were solved through discussion, involving a third reviewer if necessary. All costs were converted to 2021 euros. Reporting quality of all studies was assessed using the CHEERS 2022 checklist. RESULTS: In total, 49 out of 5552 articles were included for data extraction and assessment of reporting quality, reporting on 48 unique early detection strategies. Early detection of atrial fibrillation in asymptomatic patients was most frequently studied (n = 15) followed by abdominal aortic aneurysm (n = 8), hypertension (n = 7) and predicted 10-year CVD risk (n = 5). Overall, 43 strategies (87.8%) were reported as cost effective and 11 (22.5%) CVD-related strategies reported cost reductions. Reporting quality ranged between 25 and 86%. CONCLUSIONS: Current evidence suggests that early CVD detection strategies are predominantly cost effective and may reduce CVD-related costs compared with no early detection. However, the lack of standardisation complicates the comparison of cost-effectiveness outcomes between studies. Real-world cost effectiveness of early CVD detection strategies will depend on the target country and local context. REGISTRATION OF SYSTEMATIC REVIEW: CRD42022321585 in International Prospective Registry of Ongoing Systematic Reviews (PROSPERO) submitted at 10 May 2022.

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