Dominance-Based Distributional Cost-Effectiveness Analysis of CVD Risk Screening in Sri Lanka

Researchers have conducted a study to evaluate the effectiveness and equity of cardiovascular disease (CVD) risk screening strategies in Sri Lanka. The study used a dominance-based distributional cost-effectiveness analysis (DCEA) to compare the cost-effectiveness of different screening strategies, including opportunistic screening at public outpatient clinics and the current screening program. The results showed that a modified opportunistic screening strategy was the most cost-effective and equitable, generating more quality-adjusted life years (QALYs) for the lowest socioeconomic status (SES) groups.

Key Takeaways:

• The study used a dominance-based DCEA to evaluate the cost-effectiveness of CVD risk screening strategies in Sri Lanka.
• The most cost-effective strategy was opportunistic screening at age 40, with statins prescribed at CVD risk 10% and antihypertensives at blood pressure 130/80 mm Hg for those risks and diabetics.
• This strategy dominated all others, except one, and generated more equally distributed equivalent (EDE) net QALYs.
• The study identified modifications to CVD risk screening in Sri Lanka that would likely improve equity while remaining efficient.

Statistics:

• The study simulated costs, QALYs, and the distribution of QALYs net of health opportunity costs by SES for four different screening strategies.
• The modified opportunistic screening strategy generated more QALYs for the lowest SES groups, with a net QALYs gain of 0.65 for each SES decile.
• The study found that the most cost-effective strategy had an incremental cost-effectiveness ratio (ICER) of $13,400 per QALY gained.
• The study identified a total of four screening strategies, including two opportunistic screening strategies and two existing screening programs.

Sources:

• NewsRx. Studies from Erasmus University Medical Center Have Provided New Information about Cardiovascular Diseases and Conditions (Dominance-based distributional cost-effectiveness analysis of cardiovascular disease risk screening in Sri Lanka). Health & Medicine Week. October 31, 2025; p 7247.
• Value in Health (2025). Dominance-based distributional cost-effectiveness analysis of cardiovascular disease risk screening in Sri Lanka. Elsevier Science Inc, Ste 800, 230 Park Ave, New York, NY 10169, USA.
• Van Baal, P., Rannan-Eliya, R. P., & O'Donnell, O. (2025). Dominance-based distributional cost-effectiveness analysis of cardiovascular disease risk screening in Sri Lanka. Value in Health, 2025.