Economic Value of Multimodal Cardiovascular Screening

Mark A. Hlatky; Philip Greenland

Disclosures

Eur Heart J. 2022;43(41):4403-4405. 

In This Article

Abstract and Introduction

Abstract

Graphical Abstract

Conceptual model of the cost-effectiveness analysis of multimodal cardiovascular screening.

Introduction

Screening for disease is appropriate for conditions with long asymptomatic periods when subclinical disease can be detected using inexpensive tests acceptable to patients, then treated simply and effectively.[1] Even though population screening programmes add to healthcare costs, they can provide good value if they significantly increase the life expectancy or quality of life of the screened population.

Cardiovascular disease seems like a good target for screening, since atherosclerosis is highly prevalent in older individuals, and effective preventive treatments are available. Despite the potential advantages of cardiovascular screening, the evidence supporting it is thin and inconsistent. Screening for carotid artery stenosis is not recommended because its harms exceed its benefits.[2] There is little evidence that screening for peripheral vascular disease with measurement of the ankle–brachial index[3] or for coronary disease with stress testing is beneficial.[4] In contrast, randomized trials show that ultrasound screening for abdominal aortic aneurysms among men aged 65–75 years who have ever smoked reduces ruptures and disease-specific mortality.[5] Screening for coronary artery calcium (CAC) with computed tomography (CT) has been promising in observational studies;[6] however, while small randomized trials suggest CAC screening can improve use of preventive behaviours and medications,[7–10] there is insufficient evidence to recommend large-scale CAC screening.[11]

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