Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands.

Pieter T De Boer,Jan Jelrik Oosterheert,Sonja E Van Roeden,Chantal P Bleeker-Rovers,Cornelia C H Wielders,Wim Van Der Hoek,Frederika Dijkstra,Peter M Schneeberger,Marit M A De Lange

doi:10.3201/eid2602.181772

Pieter T De Boer, Jan Jelrik Oosterheert + Show 7 more

Open Access

https://doi.org/10.3201/eid2602.181772

Copy DOI

Abstract

In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007–2010, new chronic QF (CQF) patients continue to be detected. We developed a health-economic decision model to evaluate the cost-effectiveness of a 1-time screening program for CQF 7 years after the epidemic. The model was parameterized with spatial data on QF notifications for the Netherlands, prevalence data from targeted screening studies, and clinical data from the national QF database. The cost-effectiveness of screening varied substantially among subpopulations and geographic areas. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from cost-saving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. The cost per quality-adjusted life year of mass screening of all older adults was €70,000 in the most optimistic scenario.

Highlights

In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007–2010, new chronic QF (CQF) patients continue to be detected
For the low CQF prevalence scenario, we estimated the number of C. burnetii infections at 42,143, resulting in 414 CQF patients directly after the epidemic and 102 CQF patients in the year of screening
In a high CQF prevalence scenario, screening of cardiovascular risk patients living in high QF incidence areas during the epidemic was estimated cost-saving, whereas in a low CQF prevalence scenario the incremental cost-effectiveness ratio (ICER) was €31,737 per quality-adjusted life years (QALYs) for this subgroup

Summary

Introduction

In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007–2010, new chronic QF (CQF) patients continue to be detected. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from costsaving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. Because early detection of CQF might result in a better prognosis, local hospitals initiated multiple targeted screening studies for clinical risk groups living in areas affected by the epidemic. These studies revealed that 7%–20% of screened patients had serologic evidence of C. burnetii infection, of whom 5%– 31% had CQF [9,10,11]. We assessed the cost-effectiveness of a screening program for CQF in the Netherlands

Methods

Results

Conclusion