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The cost-effectiveness of screening for hereditary hemochromatosis in Germany: A remodeling study.

Med. Decis. Making 29, 224-238 (2009)
Open Access Green as soon as Postprint is submitted to ZB.
Genetic tests for hereditary hemochromatosis (HH) are currently included in the German ambulatory care reimbursement scheme but only for symptomatic individuals and the offspring of HH patients. This study synthesizes the most current evidence to examine whether screening in the broader population is cost-effective and to identify the best choice of initial and follow-up screening tests. Methods. A probabilistic decision-analytic model was constructed to calculate cost per life year gained (LYG) for HH screening among male Caucasians aged 30. Three strategies were considered in both the general population and male offspring of HH patients: phenotypic (transferrin saturation, TS), genotypic (C282Y mutation), and sequential (genotype if TS is elevated) screening. Results. The incremental cost-effectiveness of sequential screening among male offspring, sequential population-wide screening, and genotypic screening is 41 000, 124 000, and 161 000 (sic)/LYG, respectively. All other strategies were subject to simple or extended dominance. The results are subject to high uncertainty. The most influential parameters in the deterministic one-way sensitivity analysis are discounting of life years gained and the adherence of patients to preventive phlebotomy. Discussion. The current German policy of only screening at-risk individuals is consistent with health economic decision making based on typically accepted thresholds. However, conducting the DNA test after the first elevated TS result is more cost-effective than waiting for a second TS result as recommended by the German guidelines. Further empirical work regarding adherence to long-term prevention recommendations and explicit and well-justified guidance for the choice of discount rates in German economic evaluation are needed.
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Publication type Article: Journal article
Document type Scientific Article
Keywords cost-effectiveness analysis; genetic screening; Germany; genetic predisposition to disease; hereditary hemochromatosis; long-term survival; transferrin saturation; psychosocial impact; general-population; c282y homozygotes; genomic medicine; health-care; technology; heirs; participants
ISSN (print) / ISBN 0272-989X
e-ISSN 1552-681X
Quellenangaben Volume: 29, Issue: 2, Pages: 224-238 Article Number: , Supplement: ,
Publisher Sage
Reviewing status Peer reviewed