Smith AJ, Turner EL, Kinra S, Bodurtha JN, Chien AT. A Cost Analysis of Universal versus Targeted Cholesterol Screening in Pediatrics.
J Pediatr. 2018;196:201-207. DOI: 10.1016/j.jpeds.2018.01.027.
In 2014, the American Academy of Pediatrics changed cholesterol screening guidelines from targeted (family risk) to universal. In this study, thought to be the first of cost consequences to the US health care system of universal screening for dyslipidemia among children, the authors used multiple sources of health, health care, and economic data to perform cost-effectiveness analyses. They found that the additional cost per case of elevated cholesterol detected was $1,980 for universal versus targeted screening, and $32,170 per additional case of severe hyperlipidemia detected.
The authors used decision analysis techniques to analyze hypothetical models of universal versus targeted screening an entire birth cohort of US children once during ages 9-11 years. Over a 1-year time horizon, they considered the costs of screening, follow-up testing for positive screening results (both true and false positives), initial 6-month dietary intervention for hyperlipidemia, and medication if severe hyperlipidemia was diagnosed or the dietary intervention failed. They assumed that 19% of US children would have dyslipidemia on initial screening; health care fees from Medicaid were used for cost and cost-effectiveness calculations. With universal screening compared to targeted screening, 2.67 million more children would be screened and 126,000 more children with dysplipidemia would be identified; however, 258,000 more children had false-positive results on initial screening with the universal approach. The overall cost with universal screening was $250 million more than targeted screening for each birth cohort. The number needed to screen in order to identify 1 case of dyslipidemia was 12, and to identify 1 case of severe dyslipidemia was 111. The cost-effectiveness ratio is favorable for universal screening for dyslipidemia in general, but substantially less so for severe dyslipidemia.