title: Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations.
abstract: BACKGROUND
  Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies.
  
  
  METHODS
  Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening.
  
  
  RESULTS
  26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men.
  
  
  CONCLUSIONS
  Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening.
authors: Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia. s.selvarajah@umcutrecht.nl
authors: Sharmini
authors: S
authors: Selvarajah
authors: Jamaiyah
authors: J
authors: Haniff
authors: Gurpreet
authors: G
authors: Kaur
authors: Tee
authors: T
authors: Guat Hiong
authors: Adam
authors: A
authors: Bujang
authors: Kee
authors: K
authors: Chee Cheong
authors: Michiel L
authors: ML
authors: Bots
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D008875:Middle Aged; D011050:Policy Making; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011314:Preventive Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors