Original Title: Efectividad, seguridad y evaluación económica de las diferentes alternativas existentes en la detección precoz de la hipercolesterolemia en la edad pediátrica

Authors' objectives: The aim of this systematic review is to assess the available information related to the efficiency, effectiveness and security of the screening for HC in the paediatric population.

Authors' results and conclusions: No studies comparing the efficiency of different HC screening strategies were identified for inclusion. Furthermore, no studies were identified that assess the impact of HC screening in lowering the risk of CVD and mortality. Considering that there is no evidence to answer the research questions contemplated in the review, a small selection of papers identified in the electronic searches was discussed. These studies suggest that cholesterol levels are sustained from childhood to adulthood and an existing relationship between subclinical atherosclerosis in adulthood and hypercholesterolemia during paediatric age. It has been shown that lowering serum cholesterol in infancy defers the onset of CVD and improves quality of life in patients with homozygous familial hypercholesterolemia and very high levels of cholesterol since birth. Altogether, these findings do not provide a solid argument in favour of universal HC screening. Most children with moderate HC will not develop premature cardiovascular disease. Even though there is no expert consensus on the appropriateness of the screening for childhood HC, most experts and scientific societies recommend against the implementation of universal screening programs for the detection of childhood HC. There is no evidence to assess the balance of benefits and harms of universal screening for HC in childhood to reduce cardiovascular risk in adulthood. Most experts do not recommend screening routinely for HC during the paediatric age.

Authors' recommendations: Routine screening for hypercholesterolaemia in children aged less than 15 years is not justified. We recommend conducting a selective screening of cholesterol in children and adolescents with at least one of the following cardiovascular risk factors: diabetes, obesity, arterial hypertension, family history of premature cardiovascular disease and genetic dyslipemia with high cardiovascular risk.

Authors' methods: The following databases were searched: PubMed/MEDLINE, EMBASE, Lilacs; and the databases of the Centre for Reviews and Dissemination (CRD): NHS Economic Evaluation Database (NHS EED), Health Technology Assessment Database (HTA), Database of Abstracts of Reviews of Effects (DARE). In addition, the databases of the following government agencies, scientific societies and guidelines-developing organizations were also searched: U.S. Preventive Services Task Force, UK National Screening Committee, Canadian Task Force on Preventive Health Care, American Association of Clinical Endocrinologists, American Academy of Pediatrics, American Heart Association, Asociación Española de Pediatría y Asociación Española de Pediatría en Atención Primaria. GuiaSalud, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse. Subsequently, a manual search from the reference lists of previously identified references was conducted. Complete economic evaluation studies, experimental and observational studies with a comparison group published until March 2013, were selected for reviewing. No language restrictions were applied. The selection of studies was done according to the previously defined inclusion and exclusion criteria. Those articles that met inclusion criteria were assessed by the computer-assisted critical appraisal tool of the Basque Office for Health Technology Assessment-OSTEBA.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.iacs.es/wp-content/uploads/2017/04/754_IACS_Hipercolesterolemia.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Health Sciences Institute in Aragon (IACS)

Contact Address: Avda, San Juan Bosco, 13, planta 2

Contact Name: María Pilar Calvo Pérez

Contact Email: direccion.iacs@aragon.es