Korean Circ J.  2021 Jul;51(7):610-622. 10.4070/kcj.2021.0051.

Cost-Effectiveness Analysis of Hypertension Screening in the Korea National Health Screening Program

• Lee HY
• Lee SW
• Kim HC
• Ihm SH
• Park SH
• Kim TH

• KMID: 2517490
• DOI: http://doi.org/10.4070/kcj.2021.0051

Abstract

Background and Objectives
To evaluate the cost-effectiveness of routine hypertension (HTN) screening as a part of the national health-screening program.
Methods
Two aspects of cost-effectiveness were examined using the national general healthscreening program. First, the cost of case-finding was computed for 5-year interval age groups. Second, the cost per quality adjusted life years (QALYs) gained were estimated for 12 different scenarios varying examination starting age, pattern and interval compared with no screening.
Results
The cost of finding one new HTN case was low as 26,284 Korean won (KRW) (approximately [approx.] United States Dollar 21) for 70–79 years old to as high as 70,552 KRW for 40–44 years old. Compared with no screening, the costs per QALYs of the following screening strategies were below the incremental cost-effectiveness ratio threshold (approx. KRW 30.5 million): first screening examination with the second confirmatory examination in adults aged ≥40 years every 3 years (KRW 10.2 million), every 2 years (KRW 13.2 million), or annually (KRW 19.9 million). One-way sensitivity analyses suggest that the results were mostly influenced by the sensitivity of the first screening examination, followed by the examination rate of the second confirmatory examination.
Conclusions
HTN screening as a part of routine national health screening program was cost- effective for adults aged 40 years or older. The most cost-effective HTN screening strategy was the first screening examination with the second confirmatory examination in aged 40 years or older every 3 years.

Keyword

Hypertension; Screening; Cost analysis

Figure

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  Figure 1 Decision tree and Markov model for estimating the cost-effectiveness of screening for HTN. (A) Structure of the decision tree with the single screening examination only. (B) Structure of the decision tree with the first screening examination and the second confirmatory examination. (C) Different health status in the Markov model.CKD = chronic kidney disease; HTN = hypertension; MI = myocardial infarction.

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  Figure 2 ICER of 21 different strategies for hypertension screening.ICER = incremental cost-effectiveness ratio; QALY = quality adjusted life year.

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  Figure 3 One-way sensitivity analysis tornado plot of strategy with the first screening examination and the second confirmatory examination for the general adults over 40 years old per 2 years versus strategy with no screening.ICER = the incremental cost-effectiveness ratio.

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