Costs and Benefits of Bundled Community-Based for Carotid Artery Stenosis, Peripheral Artery Disease, and Abdominal Aortic Aneurysm

Purpose: Perform an initial formal assessment of the costs and benefits of bundled cardiovascular screening. Primarily, determine the relative importance of data uncertainties to the integrity of modeled outcomes associated with bundled screening for carotid artery stenosis (CaS), peripheral artery disease (PaD), and abdominal aortic aneurysm (aaa); secondarily, establish parameters around potential costs and outcomes benefits of this screening bundle. Design: a decision-analysis framework composed of four decision tree submodels with transition probabilities specific to four ageand genderspecific subgroups. Model transition probabilities for each of the four submodels are based on the prevalence of all possible combinations of the presence or absence of moderate CaS, significant CaS, PaD, and aaa, and the likelihood of appropriate or inappropriate medical follow-up. Methodology: Evaluates a hypothetical self-funded employer with 10,000 beneficiaries and who is considering whether to provide bundled cardiovascular health screenings. Screenings would be performed in addition to any other medical screenings commonly performed by physicians to assess cardiovascular risk. Determine costs and catastrophic events (death, myocardial infarction, stroke, other cardiovascular-related events, amputation events) for these self-funded hypothetical beneficiaries aged ≥50 years and <65 years. Results: The model predicts approximately $54 million in health care costs over 10 years for the control cohort and $51 million for the screening cohort, representing a 5.2% reduction in 10-year health care spending due to screening. Conclusion: This initial analysis predicts robust cost and health benefits associated with the decision to provide bundled cardiovascular health screening to a self-funded employer’s beneficiaries aged ≥50 years and <65 years. Further analyses are necessary to better quantify the magnitude of the cost and health benefits. INTRODUCTION Community-based screening for vascular disease is of growing popularity. nevertheless, the costeffectiveness of such consumerdirected screenings has been hotly debated (rooke 2007). In this paper, we provide an analytical framework as well as a preliminary assessment of 10-year costs and health benefits associated with a bundled package of cardiovascular health screenings. Cost-effectiveness analysis is used to examine the value, in terms of a combined measure of cost and clinical benefit (e.g., cost per correct diagnosis of disease) of one or more interventions designed to improve health (Gold 1996). These analyses are then used in the decision-making process for physicians, insurance companies, and many others (Gold 1996). Wellknown examples of cost-effectiveness analyses have examined the value of screening for at-risk populations, such as the value of mammograms to detect breast cancer in women over 40 years old (vs. women over 50) and of colonoscopies or other screening methods to detect colorectal cancer in men and women over 50 (Eddy 1989, Pharoah 2013, Barouni 2012, austin 2013). newer analyses examine the benefits of other health screenings, such as lung cancer screenings (Goulart 2013), in populations whose risk is less defined. Because new screening programs must be in place for many years before impacts on patients’ lives and health care system costs can be measured, assumption-driven costeffectiveness analyses are an appropriate step in determining screening interventions that have promise and should be investigated further. additionally, it is important to identify co-occurring diseases, as it has been demonstrated that the occurrence of multiple disease conditions is associated with health care cost escalation (Bhattacharjee 2013, Funding source: Life Line Screening, LLC, provided the data sets used for this study, funded its research and writing, participated in study design, and had editorial input on the article’s content. Conflict disclosure: Steven Weisman and Elizabeth Brooks are consultants to Life Line Screening and have received compensation