A Cost Analysis of Universal versus Targeted Cholesterol Screening in Pediatrics

Area of Science:

• Pediatric Health
• Cardiovascular Disease Prevention
• Health Economics

Background:

• Childhood dyslipidemia is a growing concern with long-term cardiovascular implications.
• Current screening strategies for hyperlipidemia in children vary, impacting early detection and intervention.
• Identifying cost-effective screening methods is crucial for public health resource allocation.

Purpose of the Study:

• To compare the number of children needing screening to detect a case of childhood dyslipidemia.
• To estimate and compare the health system costs of universal versus targeted screening approaches for childhood hyperlipidemia.
• To determine the most cost-efficient screening strategy for identifying children with severe hyperlipidemia.

Main Methods:

• A decision-analytic model was constructed to compare universal and targeted screening for hyperlipidemia in 10-year-old US children.
• Targeted screening was defined by parental dyslipidemia or early cardiovascular disease in a first-degree relative.
• Prevalence data and costs from the 2016 Maryland Medicaid fee schedule were utilized, with sensitivity analyses performed.

Main Results:

• Universal screening required screening 12 children for any hyperlipidemia and 111 for severe hyperlipidemia.
• Targeted screening identified cases by screening 7 children for any hyperlipidemia and 49 for severe hyperlipidemia.
• The incremental cost per case detected was $1980 for any hyperlipidemia and $32,170 for severe hyperlipidemia, favoring targeted screening.

Conclusions:

• Universal cholesterol screening in children is cost-effective for detecting hyperlipidemia generally.
• Targeted screening, based on family history, is more cost-efficient for identifying severe hyperlipidemia cases.
• Prioritizing targeted screening may optimize resource use for children most likely to benefit from treatment.