title: Cost effectiveness and screening interval of lipid screening in Hodgkin's lymphoma survivors.
abstract: OBJECTIVE
  Survivors of Hodgkin's lymphoma (HL) who received mediastinal irradiation have an increased risk of coronary heart disease. We evaluated the cost effectiveness of lipid screening in survivors of HL and compared different screening intervals.
  
  
  METHODS
  We developed a decision-analytic model to evaluate lipid screening in a hypothetical cohort of 30-year-old survivors of HL who survived 5 years after mediastinal irradiation. We compared the following strategies: no screening, and screening at 1-, 3-, 5-, or 7-year intervals. Screen-positive patients were treated with statins. Markov models were used to calculate life expectancy, quality-adjusted life expectancy, and lifetime costs. Baseline probabilities, transition probabilities, and utilities were derived from published studies and US population data. Costs were estimated from Medicare fee schedules and the medical literature. Sensitivity analyses were performed.
  
  
  RESULTS
  Using an incremental cost-effectiveness ratio (ICER) threshold of $100,000 per quality-adjusted life-year (QALY) saved, lipid screening at every interval was cost effective relative to a strategy of no screening. When comparing screening intervals, a 3-year interval was cost effective relative to a 5-year interval, but annual screening, relative to screening every 3 years, had an ICER of more than $100,000/QALY saved. Factors with the most influence on the results included risk of cardiac events/death after HL, efficacy of statins in reducing cardiac events/death, and costs of statins.
  
  
  CONCLUSIONS
  Lipid screening in survivors of HL, with statin therapy for screen-positive patients, improves survival and is cost effective. A screening interval of 3 years seems reasonable in the long-term follow-up of survivors of HL.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA. achen7@partners.org
authors.forename: Aileen B
authors.initials: AB
authors.lastname: Chen
authors.forename: Rinaa S
authors.initials: RS
authors.lastname: Punglia
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mauch
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Ng
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis*; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D011788:Quality of Life; D015203:Reproducibility of Results; D016019:Survival Analysis; D017741:Survivors
chemical_list: D008055:Lipids