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

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.

Fig. 1

2020 PRISMA flow chart showing the reviewing process

Fig. 2

Incremental health economic outcomes of all papers reporting both costs and quality-adjusted life-years (QALYs). The colour represents the targeted disease of the early detection strategy and the shape reflects the authors’ conclusion. The dashed line represents the Dutch willingness-to-pay threshold of €20,000/QALY. One publication [39] reported both incremental costs and QALYs, but had such large QALY gain (2.87) that it was removed from this figure for visualisation purposes

Fig. 3

Reporting quality of health economic articles over the included time period, i.e. from January 2016 until May 2022. The colours represent the target disease and the horizontal lines separate low, medium, and high quality articles. For visability, some noise was added to the x-value

Fig. 4

Overview of how many articles reported on each item of the 2022 CHEERS checklist