Browsing by Subject "Lipid lowering therapy"
Now showing 1 - 1 of 1
- Results Per Page
- Sort Options
Item Temporal trends in pediatric and young adult lipid testing and treatment and cost-effectiveness analysis of universal vs. pediatric lipid screening methodology in the U.S.(2019-02-06) Chen, Linda; Rascati, Karen L.; Wilson, James P.Introduction: In 2011, the National Heart, Lung, and Blood Institute recommended universal lipid screening of all youth and adolescents at ages 9-11 and 17-21 years of age. In contrast, the U.S. Preventative Services Task Force statement could not recommend screening one way or another. The difference was due to limited data on the effect of early screening and treatment, especially in the 20-35 year old population, and limited cost-effectiveness evidence for universal screening. Purpose: The purpose of this study was to examine real-world temporal trends in lipid testing, dyslipidemia, and lipid lowering therapy (LTT) utilization in ages 2-30 for 2007-2012, and to estimate the cost-effectiveness of universal vs. selective pediatric lipid screening. Methods: Temporal trends were analyzed using retrospective claims and electronic health record data from three different health care systems across the U.S. The prevalence of lipid testing, dyslipidemia, and LLT utilization were determined for each year. Two-sided Cochran-Armitage methods were used to assess trend changes. The cost-effectiveness model combined two different models. The first was a Markov Model for US 10 year-old children that predicted the distribution of the population with dyslipidemia and their percentage LDL-C reduction at age 35 under universal screening and selective screening. Data from the first model were input into the existing Cardiovascular Disease Model. The cohort was followed until age 55 and estimates of the predicted total costs and quality-adjusted life years (QALY) were calculated. Results: Comparing age groups 2-20 years and 21-30 years, the prevalence in lipid testing decreased from 4.4% to 2.0% and 9.1% to 5.7%, and the prevalence of LLT decreased from 0.04% to 0.02% and from 0.35% to 0.12% , respectively (all: p<0.0001). The prevalence of normal LDL increased from 84.9% to 90.0% (p<0.0001) and 77.2% to 83.3% (p<0.0001) in the 2-20 and 21-30 age groups, respectively. Universal screening was more costly and more effective than selective screening, generating an incremental cost-effectiveness ratio of $65,048/QALY. Discussion: Rates of lipid testing and LLT were consistent with other literature but lower than predicted and unexpectedly declining despite recommendations to increase lipid screening. Our model found universal lipid screening to be cost-effective compared to selective screening at willingness to pay of 100,000, although further data are needed to supplement model assumptions.