Evaluating the cost-effectiveness of enhanced cardiovascular-renal-metabolic (CVRM) screening in UK, France, Germany and Australia: a microsimulation-based enhanced CVRM screening analysis.

Enhanced CVRM screening was projected to reduce mortality in all four countries over 20 years among people aged ≥35 years, with benefits growing over time.

• Mortality reductions ranged from 109,863 in Australia to 467,297 in Germany.
• Most survival gains accrued after the first decade.
• A discrete-time patient-level microsimulation projected 20-year health trajectories calibrated to country-specific demographic and epidemiologic profiles.

Enhanced screening was projected to generate large numbers of life-years gained in all four countries.

• Life-years gained ranged from 640,870 to 2,803,783 across countries (Australia lowest, Germany highest by the mortality pattern).
• Benefits were consistent across countries and increased over time.
• Population was aged ≥35 years over a 20-year horizon.

Under the modeled assumptions, the enhanced screening strategy was cost saving in all four countries and dominant from payer and societal perspectives.

• Total savings ranged from $368.9 million in Australia to $46.5 billion in Germany.
• Analyses used country-specific costs and wages.
• Strategy was compared against current standard of care (SoC).

Enhanced screening was also projected to provide additional healthcare, societal and environmental benefits.

• Benefits included fewer hospital bed-days and lower productivity losses.
• CO2-equivalent emissions were reduced, using country-specific emission factors.
• Analyses were conducted from payer, societal, and environmental perspectives.

The enhanced strategy differed from standard of care by broader eligibility, more frequent screening, and assessment of key CVRM indicators, and modeled six interacting conditions.

• Conditions modeled were hypertension, type 2 diabetes, chronic kidney disease, dyslipidemia, obesity, and heart failure.
• Disease progression used validated country-specific risk equations capturing multimorbidity and dynamic risk interactions.

Results depended on structural and epidemiologic assumptions, and uncertainty analysis was limited to deterministic sensitivity analysis.

• Key assumptions included screening uptake, disease progression, and risk equation recalibration.
• Deterministic sensitivity analyses varied key parameters by ±20%.
• Probabilistic sensitivity analysis was not performed.

The authors conclude that comprehensive CVRM screening, when embedded in preventive care pathways with appropriate follow-up, may improve population health while generating economic, societal and environmental benefits.

• Benefit realization is conditional on linkage to appropriate follow-up care.