Sensitivity to Key Parameter Changes
| Parameter | Health Impact QALY | Cost-Effectiveness $ | Cardiovascular Disease Event, No. | Total Cost $ Million |
|---|---|---|---|---|
| Aspirin for primary prevention | ||||
| Base case | 2,200 | 31 saved pp | −530 | −3.1 |
| Treatment efficacy | ||||
| Low | 200 | 91,700/QALY | −50 | 2.5 |
| High | 4,000 | 68 saved pp | −910 | −6.8 |
| Treatment effectiveness | ||||
| −10% (60% effectiveness) | 1,800 | 18 saved pp | −370 | −1.8 |
| +10% (80% effectiveness) | 2,600 | 45 saved pp | −720 | −4.5 |
| Disease costs | ||||
| −25% | 2,200 | 17 saved pp | −530 | −1.7 |
| +25% | 2,200 | 45 saved pp | −530 | −4.5 |
| Screening and medication costs | ||||
| Screening (clinic) costs, −25% | 2,200 | 32 saved pp | −530 | −3.2 |
| Screening (clinic) costs, +25% | 2,200 | 30 saved pp | −530 | −3.0 |
| Bulk aspirin (−35%), $11.93/y | 2,200 | 36 saved pp | −530 | −3.6 |
| Name brand aspirin (+32%), $24.04/y | 2,200 | 27 saved pp | −530 | −2.7 |
| No patient time cost | 2,200 | 37 saved pp | −530 | −3.7 |
| QALY decrements | ||||
| −0.10 QALY | 2,100 | 31 saved pp | −530 | −3.1 |
| +0.10 QALY | 2,300 | 31 saved pp | −530 | −3.1 |
| Cholesterol screening | ||||
| Base case | 14,300 | 33,800/QALY | −3,960 | 80.1 |
| Treatment effectiveness | ||||
| −10% (60% effectiveness) | 12,400 | 35,100/QALY | −3,510 | 71.8 |
| +10% (80% effectiveness) | 18,300 | 27,200/QALY | −5,140 | 81.9 |
| Disease costs | ||||
| −25% | 14,300 | 37,600/QALY | −3,960 | 89.2 |
| +25% | 14,300 | 30,000/QALY | −3,960 | 71.0 |
| Screening, management, and medication costs | ||||
| Screening and management (clinic) costs, −25% | 14,300 | 30,800/QALY | −3,960 | 73.0 |
| Screening and management (clinic) costs, +25% | 14,300 | 36,800/QALY | −3,960 | 87.2 |
| Discount generic medications (−91%), $36.70/y | 14,300 | 5,300/QALY | −3,960 | 12.6 |
| Name brand medications (+804%), $3,818.73/y | 14,300 | 284,800/QALY | −3,960 | 675.1 |
| No patient time cost | 14,300 | 28,000/QALY | −3,960 | 66.4 |
| QALY decrements | ||||
| −0.10 QALY | 13,400 | 37,400/QALY | −3,960 | 80.1 |
| +0.10 QALY | 15,000 | 31,400/QALY | −3,960 | 80.1 |
| Hypertension screening | ||||
| Base case | 15,600 | 48,500/QALY | −4,000 | 122.9 |
| Treatment effectiveness | ||||
| −10% (60% effectiveness) | 11,800 | 60,300/QALY | −3,060 | 115.7 |
| +10% (80% effectiveness) | 19,800 | 39,700/QALY | −5,100 | 127.1 |
| Disease costs | ||||
| −25% | 15,600 | 52,000/QALY | −4,000 | 131.6 |
| +25% | 15,600 | 45,100/QALY | −4,000 | 114.2 |
| Screening, management, and medication costs | ||||
| Screening and management (clinic) costs, −25% | 15,600 | 44,400/QALY | −4,000 | 112.5 |
| Screening and management (clinic) costs, +25% | 15,600 | 52,500/QALY | −4,000 | 133.1 |
| Discount generic medications (−82%), $36.70/y | 15,600 | 26,200/QALY | −4,000 | 66.5 |
| Name brand medications (+1,973%), $4,216.16/y | 15,600 | 584,600/QALY | −4,000 | 1,481.0 |
| No patient time cost | 15,600 | 34,200/QALY | −4,000 | 86.6 |
| QALY decrements | ||||
| −0.10 QALY | 14,900 | 52,300/QALY | −4,000 | 122.9 |
| +0.10 QALY | 15,700 | 46,800/QALY | −4,000 | 122.9 |
CE = cost-effectiveness; CVD = cardiovascular disease; pp = per person; QALY = quality-adjusted life years.
Note: Cost-effectiveness is expressed in terms of incremental costs per QALY, unless a preventive service is cost-saving overall, in which case, it is expressed in terms of costs saved per person. Sources for the sensitivity ranges for medication costs are described in the Supplemental Appendix (Supplemental Appendix http://www.annfammed.org/content/15/1/23/suppl/DC1). All costs are expressed in 2012 US dollars.