To Screen or Not to Screen?

Money is always a hot topic in healthcare – where it’s going, why it’s being spent, and how we can get more value out of each cent. Indeed, diseases are often referred to by their economic burdens, and it is by regulators’ weighting of cost benefit versus quality-of-life gains that therapeutics and diagnostic solutions are often assessed. Sometimes, not to intervene is deemed the favorable solution – and it is this strategy that has recently been suggested for the screening of lipid disorders in children.

After nine years, the United States Preventive Services Task Force (USPSTF) has updated its guidelines on screening for lipid disorders in people under 20. The screening received an I statement, meaning that “current evidence is insufficient to assess the balance of benefits and harms of screening (1)” – but not everyone agrees. Earlier recommendations from the National Heart, Lung, and Blood Institute (NHLBI) were strongly in favor of screening “unless a clear and compelling rationale for an alternative approach is present. (2)”

Is there such a rationale? The authors of a recent JAMA Internal Medicine editorial believe so (3). They argue that screening for low-likelihood issues like cardiovascular disease events in children results in costs and harms without accompanying benefit – especially if they receive treatments like statin drugs, which can increase the risk of diabetes mellitus. Furthermore, they add that if the USPSTF had considered the cost-effectiveness of screening in its evaluation, the outcome would most likely have been a grade of D: “Discourage the use of this service.” It seems that an uncertain future is ahead for childhood lipid screening…