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WHO/HGN/FH/CONS/98.7
page 32

Association of FH, British Family Heart Association, US Inherited High Cholesterol Foundation are working to raise awareness and promote help for patients with FH and other severe lipid disorders.  All of these efforts can now benefit from an understanding of the favourable cost effectiveness of helping FH patients compared to other supported health measures.

Thus, case finding ("MedPed") and treatment of FH are cost effective and affordable when compared to other commonly supported health measures.  Statin therapy for males with FH is 4-times more cost effective than  generic drug therapy for high blood pressure  or dialysis for kidney failure.  Because costs may vary by country, the methods are presented to permit recalculations.  Other countries should consider following the example of a few who already provide government funding for two major needs for FH patients around the world:

     a.  Supporting the cost of medications for FH patients who lack private insurance
     b.  Supporting MedPed family screening and education of patients and their physicians

Future trends such as generic statin medications will make an already cost effective treatment even more favourable.


14.  MEDPED PARADIGM FOR OTHER DISORDERS


The MedPed approach to the case-finding of subjects with heterozygous familial hypercholesterolaemia (hFH) is a collaborative effort between patients, their families and health care providers, such as primary care physicians, specialists, nutritionists, nurses and public health officials.  While the precise implementation and personnel may vary, the paradigm is basically the same for all participating centres.  The process involves establishing an efficient system of contacting persons who are at high risk of hFH by virtue of their genetic relationship with a known hFH index patient, notifying them of this risk, and providing them with concrete options for education, action and follow-up. 
For hFH, the MedPed paradigm is appropriate for several reasons.  First is the relatively high prevalence (for a genetic disorder) of hFH in most jurisdictions, making it a disproportionately frequent cause of early atherosclerosis and thus an important public health problem.  Second is the depth and breadth of understanding of the genetics, molecular biology, natural history and clinical consequences of hFH, which provides the scientific ballast and rationale for the MedPed hFH approach.  Third is the relatively long latent period before hFH produces serious clinical consequences, which allows for time to make the diagnosis and to institute
preventive measures.  Fourth is the availability of acceptable and reliable diagnostic tests, usually involving venipuncture for biochemical and/or genetic assessment, and of people to interpret them.  Fifth is the availability of acceptable and effective evidence-based intervention strategies.  Sixth is the availability of support and information for patients, families and primary health care providers.  Finally, MedPed hFH has produced a permanent registry of affected subjects, which allows for ongoing case-finding and follow-up.

Is the strategy of case-finding in high-risk kindreds more effective than other strategies, such as screening at the onset of coronary heart disease (CHD) or general population screening to find new hFH patients?  For the former, compared with the general population, hFH is associated with up to a 96-fold increase in CHD morality, particularly below age 40 [37].  Since the first manifestation of CHD is often sudden death, the strategy of waiting for the onset clinical manifestations will cost lives.  For the latter, the ascertainment and confirmation of new hFH cases by the MedPed hFH approach was demonstrated to be about 4-times more cost-effective than finding them through general cholesterol screening [62].  For instance, given the autosomal

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