On the Optimization of Cholesterol Screening

Total serum cholesterol is a major risk factor for Coronary Heart Disease (CHD). Some guidelines have been published regarding treatment levels. However, before implementing cholesterol screening, the costs and benefits should be analyzed as a function of cholesterol level. Analysis is readily implemented on microcomputer spreadsheets using decision tree analysis. Because it is very difficult to establish some of the costs satisfactorily, the facility of spreadsheets in performing sensitivity analysis is crucial. Here, plausible numerical values are used as “default” conditions for estimating in a preliminary way the costs and benefits of a putative screening-intervention program. The cost-benefit condition remains very close to optimal over the range 200-240 mg/dl for cholesterol marker level. The optimal condition may shift considerably when the default parameter values are altered. With the default values, the maximal net benefit is around 5% of the estimated current costs of CHD deaths without screening.

Key-Words

Cholesterol - Screening - Decision Tree - Optimization - Spreadsheets

• References

• 1 Amler RW, Moriarty DG, Hutchins EB. eds. Healthier People: The Carter Center of Emory University Health Risk Appraisal Program Guides and Documentation. (Vol4: Scientific Documentation). Atlanta: The Carter Center of Emory University; January 1988
• 2 Truett J, Cornfield J, Kannel W. A multivariate analysis of the risk of coronary heart disease in Framingham. J Chronic Diseases 1967; 20: 511-24.
• 3 Milsum JH. Determining optimal screening policies, using decision trees and spreadsheets. Comp Biol Med 1989; 19: 231-43.
• 4 Fries JF. Aging, illness, and health policy: Implications of the compression of morbidity. Persp Biol Med 1988; 31: 407-28.
• 5 Ragland DR, Brand RJ. Coronary heart disease mortality in the Western Collaborative Group Study. Amer J Epid 1988; 127: 462-75.
• 6 Multiple Risk Factor Intervention Trial Research Group. Coronary heart disease death, nonfatal acute myocardial infarction and other clinical outcomes in the Multiple Risk Factor Intervention Trial. Amer J Card 1986; 58: 1-13.
• 7 Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. JAMA 1982; 248: 1465-77.
• 8 Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251: 351-64.
• 9 Hall JH, Zwemer JD. Prospective Medicine. Methodist Hospital of Indiana. 1979
• 10 Smith KW, McKinlay SM, Thorington BD. The validity of Health Risk Appraisal instruments for assessing coronary heart disease risk. AJPH 1987; 77: 419-24.
• 11 Castelli WP, Garrison MS, Wilson PWF. et al. Incidence of coronary heart disease and lipoprotein cholesterol levels: The Framingham Study. JAMA 1986; 256: 2835-8.
• 12 Grundy SM. Cholesterol and coronary heart disease. JAMA 1986; 256: 2849-58.
• 13 Lovastatin Study Group II. Therapeutic response to Lovastatin (Mevinolin) in nonfamilial hypercholesterolemia. JAMA 1986; 256: 2829-34.
• 14 The Expert Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 1988; 148: 36-69.
• 15 Morgernstem H, Bursic ES. A method for using epidemiological data to estimate the potential impact of an intervention on the health status of a target population. J Comm Health 1982; 07: 292-309.
• 16 Stamler J, Wentworth D, Neaton JD. (For the MRFIT Research Group.) Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded?. JAMA 1986; 256: 2823-8.
• 17 Weinstein MC, Coxson PG, Williams LW. et al. Forecasting coronary heart disease incidence, mortality, and cost: the coronary heart disease policy model. AJPH 1987; 77: 1417-26.
• 18 Cretin S. Cost/benefit analysis of treatment and prevention of myocardial infarction. Washington DC: National Center for Health Services Research; 1977: 174-89.
• 19 Lotus 1-2-3 Software Manual. Release 2.01. Lotus Development Corporation. 1986
• 20 VP-Planner Plus Software Manual. Paperwork Software International. 1987
• 21 Milsum JH. Health, Stress, and Illness: A Systems Approach. New York: Praeger; 1984
• 22 Petersen PH, Horder M. Ways of assessing quality goals for diagnostic tests in clinical situations. Arch Pathol Lab Med 1988; 112: 435-43.