Dominance-Based Distributional Cost-Effectiveness Analysis of Cardiovascular Disease Risk Screening in Sri Lanka

Area of Science:

• Public Health
• Health Economics
• Epidemiology

Background:

• Cardiovascular disease (CVD) risk screening is crucial for cost-effective healthcare.
• The impact of CVD screening on health equity varies by socioeconomic status (SES).
• Key factors influencing screening effectiveness include target population, risk factor distribution, and treatment criteria.

Purpose of the Study:

• To conduct a distributional cost-effectiveness analysis of CVD risk screening strategies in Sri Lanka.
• To compare equity-efficiency trade-offs of different screening approaches.
• To identify optimal screening strategies considering socioeconomic disparities.

Main Methods:

• Utilized nationally representative data to model four opportunistic screening strategies at public clinics.
• Employed an assets index to measure socioeconomic status (SES).
• Simulated costs, quality-adjusted life-years (QALYs), and their distribution across SES groups, applying generalized concentration curve dominance.

Main Results:

• The most cost-effective strategy involved opportunistic screening from age 40, with specific risk thresholds for statins (≥10% CVD risk) and antihypertensives (≥130/80 mm Hg).
• This strategy also included management for people with diabetes.
• The identified strategy dominated others, demonstrating superior equity and efficiency, particularly in generating equally distributed equivalent net QALYs.

Conclusions:

• Dominance-based distributional cost-effectiveness analysis successfully identified improved CVD risk screening modifications for Sri Lanka.
• The recommended strategy enhances both health equity and efficiency.
• Adjustments in screening age and prescription criteria are key to optimizing CVD risk management.