Abstract
Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Early detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40-75 in comparison to care as usual (the no-screening baseline scenario). A cost-effectiveness analysis (CEA) was carried out from the payer and societal perspectives, and the short-term (from screening until diagnosis has been established) cost per identified case of hypertension and long-term (20 years) cost per quality-adjusted life year (QALY) were reported. Data on the short-term cost were based on a real-world screening programme in which 2025 healthy individuals were screened for hypertension. Data on the long-term cost were based on the short-term outcomes combined with modelling in a Markov cohort model. Deterministic and probabilistic sensitivity analyses were carried out to assess uncertainty. The short-term analysis showed an additional cost of 4,800 SEK (€470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (€1,240). The long-term analysis showed a payer cost per QALY of 2.2 million SEK (€210,000) and from the societal perspective 2.8 million SEK per QALY (€270,000). The long-term model results showed that the screening model is unlikely to be cost-effective in a country with a well-developed health-care system and a relatively low prevalence of hypertension.
Highlights
Hypertension or high blood pressure (BP) is an important worldwide public health problem and the most important risk factor for the total disease burden worldwide [1], with its sequelae including stroke and myocardial infarction [2]
We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40–75 in comparison to care as usual
The short-term analysis showed an additional cost of 4,800 Swedish kronor (SEK) (€470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (€1,240)
Summary
Hypertension or high blood pressure (BP) is an important worldwide public health problem and the most important risk factor for the total disease burden worldwide [1], with its sequelae including stroke and myocardial infarction [2]. It is estimated that 10% of health-care spending is directly related to hypertension and its complications [3]. Since there are effective treatments that reduce both high BP and an individual’s risk of developing sequelae [6], it is important to identify those individuals who have high BP as early as possible. Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40–75 in comparison to care as usual (the no-screening baseline scenario)
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