title: Modeling the costs and long-term health benefits of screening the general population for risks of cardiovascular disease: a review of methods used in the literature.
abstract: BACKGROUND
  Strategies for screening and intervening to reduce the risk of cardiovascular disease (CVD) in primary care settings need to be assessed in terms of both their costs and long-term health effects. We undertook a literature review to investigate the methodologies used.
  
  
  METHODS
  In a framework of developing a new health-economic model for evaluating different screening strategies for primary prevention of CVD in Europe (EPIC-CVD project), we identified seven key modeling issues and reviewed papers published between 2000 and 2013 to assess how they were addressed.
  
  
  RESULTS
  We found 13 relevant health-economic modeling studies of screening to prevent CVD in primary care. The models varied in their degree of complexity, with between two and 33 health states. Programmes that screen the whole population by a fixed cut-off (e.g., predicted 10-year CVD risk >20 %) identify predominantly elderly people, who may not be those most likely to benefit from long-term treatment. Uncertainty and model validation were generally poorly addressed. Few studies considered the disutility of taking drugs in otherwise healthy individuals or the budget impact of the programme.
  
  
  CONCLUSIONS
  Model validation, incorporation of parameter uncertainty, and sensitivity analyses for assumptions made are all important components of model building and reporting, and deserve more attention. Complex models may not necessarily give more accurate predictions. Availability of a large enough source dataset to reliably estimate all relevant input parameters is crucial for achieving credible results. Decision criteria should consider budget impact and the medicalization of the population as well as cost-effectiveness thresholds.
authors.affiliation: Department of Applied Economics, University of Granada, Campus de la Cartuja, 18071, Granada, Spain. davidepstein@ugr.es.|Escuela Andaluza de Salud Pública, Granada, Spain. davidepstein@ugr.es.
authors.forename: David
authors.initials: D
authors.lastname: Epstein
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: García-Mochón
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kaptoge
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006293:Health Promotion; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011322:Primary Prevention / Q000191:economics; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Cost-effectiveness analysis; Literature review; Primary prevention; Screening; Statins