Description
Background
Disease screening, particularly in the context of non-communicable diseases(NCDs), plays a crucial role in disease prevention, reducing morbidity and mortality rates, and promoting cost-effective healthcare. Identifying diseases at early stages or in asymptomatic individuals, screening programs enable timely interventions, thus improving health outcomes. Moreover, the cost-effectiveness of early detection and treatment underscores the value of screening in reducing healthcare expenditures associated with advanced disease management. As healthcare systems continue to evolve, investing in comprehensive and accessible screening programs becomes increasingly important for the well-being of individuals and the overall population.
Methodology
This study aims to demonstrate the costs and benefit of cardiovascular screening programme in Sri Lanka. National level NCD program costs were taken from National allocations from 2016-2020, the National Multisectoral Action Plan for the Prevention and Control of NCDs(2016–2020) Sri Lanka. It was assumed that 50% of the allocations for Health system strengthening and early detection and management of NCDs were allocated for screening. The Benefit is considered of screening working age group people. In calculating the benefits, the objectives of the NCD program were used. Twenty percent(20%) of the target population (35 years and above) is screened annually. The high-risk CVD was based on WHO/ISH 2007 >30% threshold. Evidence suggests that in LMICs such as Sri Lanka, NCD-related morbidity and mortality are highest among working-age people. Therefore, in the current analysis, the benefit was calculated in terms of averted lost earnings. Lost earnings were calculated for a Blue- and White-collar worker separately (per patient if he/she is removed from work at 50 years due to death or disability). The monetary values of all measures were based on Sri Lankan rupees (SLR). Cost-Benefit Analysis was conducted and benefit-to-cost-ratio(BCR) was calculated.
Results
Employee who is 50 years old dies or becomes disabled, the total lost earnings for a government sector worker would be Rs. 4.6 million, for an informal sector worker would be Rs. 3.3 million. The Benefit-to-cost-ratio(BCR) for each year from 2016- to 2020; 2016-BCR 8.7, 2017-BCR 4.4, 2018-BCR 3.4, 2019 BCR 4.3 and 2020 BCR 1.1. The projected cost necessary for the screening programme in 2023 for maximum benefit(20% population) based on WHO / ISH 2007 is Rs million 1021 and if WHO ISH/2019 is implemented Rs. Million 777. 6. To screen 10 % of the target population the cost necessary is Rs. Million 510 to WHO/ ISH 2007 and Rs. Million 389. The screened % of the target population has been declining over the years. The Benefit-to-Cost-Ratio has declined over the years as a result of the percentage of screened population has declined. BCR from 2016 to 2019 has been nearly 4 and in 2020 the BCR has drastically dropped.
Conclusions
Therefore, the benefit of the programme has not been optimized. Measures should be taken to increase screening of the target population to maximise the benefit. Costing of the screening programme and scenario-based costing of identifying and managing a high-risk CVD patient is recommended to improve the analysis.
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