Abstract
BACKGROUND：China has invested substantial resources in screening and intervening with people at high risk of stroke in the past decade. Surprisingly, the weighted prevalence of stroke has still increased, highlighting the necessity to explore more cost-effectiveness screening strategies.
METHODS：A decision tree-Markov model was used to evaluate the quality-adjusted life-year (QALY), costs, and incremental cost-effectiveness ratio (ICER) of different screening strategies, including no screening, Homocysteine(Hcy) testing and “8+2” risk-scorecard with Hcy-testing. Screening frequencies were set at biennial, triennial, and lifetime intervals, with initial screening ages of 40, 50, 60, and 70 years.
RESULTS：The biennial Hcy testing had the highest ICER when the screening age was 40 and 50 years old, which were 3377.7 ￥/QALY and 944.6 ￥/QALY respectively. However, when the screening age was 60 and 70 years old, the biannual Hcy testing shows a reduced cost and increased effectiveness, the ICER were -2933.9￥/QALY and -2349.6￥/QALY respectively.
CONCLUSIONS：In China, the biannual “8+2” risk-scorecard combined with Hcy testing for screening high-risk stroke groups at ages 40 or 50 represents the most cost-effectiveness approach. For individuals aged 60 or 70, the biannual Hcy testing is the recommended strategy.