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The Cost-Effectiveness of Screening for Hereditary Hemochromatosis in Germany: A Remodeling Study

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  • Wolf H. Rogowski

    (Helmholtz Zentrum München, German Research Center for Environmental Health Institute of Health Economics and Health Care Management, Neuherberg, Germany, Rogowski@helmholtz-muenchen.de)

Abstract

Objective . 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 /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.

Suggested Citation

  • Wolf H. Rogowski, 2009. "The Cost-Effectiveness of Screening for Hereditary Hemochromatosis in Germany: A Remodeling Study," Medical Decision Making, , vol. 29(2), pages 224-238, March.
    • Handle: RePEc:sae:medema:v:29:y:2009:i:2:p:224-238
    DOI: 10.1177/0272989X08327112
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
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    1. Fernando Antoñanzas & R. Rodríguez-Ibeas & M. Hutter & R. Lorente & C. Juárez & M. Pinillos, 2012. "Genetic testing in the European Union: does economic evaluation matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 651-661, October.
    2. Rogowski, Wolf H. & Schleidgen, Sebastian, 2015. "Using needs-based frameworks for evaluating new technologies: An application to genetic tests," Health Policy, Elsevier, vol. 119(2), pages 147-155.

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