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Effectiveness of interventions to increase screening uptake
abnormalities starting at around age 45–50, with repeated tests every five years. This is similar to the current recommendation of the canadian Task Force on Preventive Health care (2012). community-based screening interventions to control hypertension appear to be cost-effective. Gu et al. (2015) develop a model to assess the cost-effectiveness of hypertension screening, coupled with pharmacotherapy, in china. They report that the program has the potential to prevent about 800,000 cardiovascular events annually at a cost of Int$13,000 (Srl 20,020) per QAlY gained. Yosefy et al. (2003) report favorable results for an outreach program in Ashkelon, Israel, that screened residents for hypertension, obesity, smoking, and hypercholesterolemia in clinics, community centers, places of employment, and homes. Any individual who was deemed high risk was referred to a treatment center. The program was associated with declines in blood pressure, weight, and mortality from acute myocardial infarction, cardiovascular disease, and hypertension at an estimated cost of uS$506 (Srl 1,898) per life year saved. The program also increased smoking cessation but had no effect on total cholesterol. A systematic review of the literature by Zhang, Wang, and Joo (2017) concludes that community-wide hypertension screening initiatives cost from uS$21,734 to uS$56,750 (Srl 81,503 to Srl 212,813) per QAlY in the united States; uS$613 to uS$5,637 (Srl 2,299 to Srl 21,139) per QAlY in Australia; and uS$7,000 to uS$18,000 (Srl 26,250 to Srl 67,500) per QAlY in china. even in a low-resource rural area of Nepal, screening coupled with effective treatment appears to be very cost-effective (Krishnan et al. 2019). Another study concludes that screening for and treatment of hypertension in the united States cost uS$48,500 (Srl 181,875) per QAlY (Dehmer et al. 2017).
Only one recent study in a high-income country has assessed the costeffectiveness of cholesterol screening and treatment. It reports a costeffectiveness ratio of uS$33,800 (Srl 126,750) per QAlY (Dehmer et al. 2017). because of patent expirations, the prices of top-selling statins have declined since the study was conducted. All other things equal, cholesterol screening could become more cost-effective.
Overall, the cost-effectiveness of screening varies widely by the condition being screened for; even within a given condition, there is sometimes wide variation in cost-effectiveness estimates (table 8.6).
Screening is distinct from interventions designed to increase screening uptake. This section summarizes studies evaluating interventions designed to boost screening uptake. Supply-side interventions (which focus on scaling up, financing, and incentivizing screening) are summarized first. Demand-side interventions (which focus on increasing the demand for and use of screening programs) can be targeted toward either an individual patient or a community.
Supply-side interventions
Interventions targeting providers may have small to moderate effects, but the evidence is mixed. educational outreach visits to health care professionals (termed academic detailing) are found to induce “small to moderate changes” in the
