The reduced cost of providing a nationally recognised service for familial hypercholesterolaemia

Abstract

ObjectiveFamilial hypercholesterolaemia (FH) affects 1 in 500 people in the UK population and is associated with premature morbidity and mortality from coronary heart disease. In 2008, National Institute for Health and Care Excellence (NICE) recommended genetic testing of potential FH index cases and cascade testing of their relatives. Commissioners have been slow to respond although there is strong evidence of cost and clinical effectiveness. Our study quantifies the recent reduced cost of providing a FH service using generic atorvastatin and compares NICE costing estimates with three suggested alternative models of care (a specialist-led service, a dual model service where general practitioners (GPs) can access specialist advice, and a GP-led service).MethodsRevision of existing 3 year costing template provided by NICE for FH services, and prediction of costs for running a programme over 10 years. Costs were modelled for the first population-based FH service in England which covers Southampton, Hampshire, Isle of Wight and Portsmouth (SHIP). Population 1.95 million.ResultsWith expiry of the Lipitor (Pfizer atorvastatin) patent the cost of providing a 10-year FH service in SHIP reduces by 42.5% (£4.88 million on patent vs £2.80 million off patent). Further cost reductions are possible as a result of the reduced cost of DNA testing, more management in general practice, and lower referral rates to specialists. For instance a dual-care model with GP management of patients supported by specialist advice when required, costs £1.89 million.ConclusionsThe three alternative models of care are now <50% of the cost of the original estimates undertaken by NICE.

Cost effectiveness of cascade testing for familial hypercholesterolaemia, based on data from familial hypercholesterolaemia services in the UK

“…It was assumed that 72% of those treated take atorvastatin, 20% simvastatin and 8% rosuvastatin. 16 The distribution of adult daily dosages for each medication was taken from the 2010 audit. 15 In sensitivity analysis, we modelled the impact of a reduction in the price of rosuvastatin and ezetimibe when UK patent protection ends in 2017.…”

International Developments in the Care of Familial Hypercholesterolemia: Where Now and Where to Next?

“…A detailed and robust health economic evaluation of community detection, cascade screening, genetic testing, and treatment of patients identified with FH is requisite for supporting the case for funding by government bodies. Current health economic evaluations from the Netherlands 19) , Australia 20) , and the United Kingdom 21) have shown that cascade screening, including genetic testing, is a costeffective approach to detect FH. However, healthcare systems, population characteristics, and available resources in different countries require local models of care for FH detection and care.…”

“…Clinical registries and decision support systems can help coordinate cascade screening and increase efficiency of healthcare services 89) . PASS clinical software has been successfully employed in Wales and the Netherlands to support FH cascade testing 21,90) . Patient registries can also be instruments for clinical research and improving healthcare planning and patient care.…”

“…Most countries do not have a formal screening program for FH. International 1) and local guidelines 3, 10-17) , models of care 18) and health economic evaluations [19][20][21] have been published, but their recommendations remain to be effectively implemented. International efforts aimed at implementing models of care ( Fig.…”

Improving the cost-effectiveness equation of cascade testing for familial hypercholesterolaemia

“…A recent paper by Pears et al [ 31 ▪▪ ] examined the cost-effectiveness of three alternative models of care for familial hypercholesterolaemia. The first model considered was a specialist-led model.…”