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

Introduction Cardiovascular-renal-metabolic (CVRM) conditions, including hypertension, type 2 diabetes, chronic kidney disease, dyslipidemia, obesity, and heart failure, are major drivers of morbidity, mortality, and healthcare costs in the United Kingdom, France, Germany, and Australia. This study evaluated the 20-year clinical, economic, societal, and environmental impact of implementing a comprehensive CVRM screening strategy versus current standard of care (SoC) in these four countries.Methods A discrete-time patient-level microsimulation model projected 20-year health trajectories calibrated to country-specific demographic and epidemiologic profiles. The enhanced screening strategy included broader eligibility, more frequent screening, and assessment of key CVRM indicators relative to SoC. Disease progression across six CVRM conditions was modeled using validated country-specific risk equations capturing multimorbidity and dynamic risk interactions. Analyses were conducted from payer, societal, and environmental perspectives using country-specific costs, wages, and CO2-equivalent emissions factors. Deterministic sensitivity analyses varied key parameters by ±20%.Results Enhanced CVRM screening produced consistent benefits across all countries that increased over time. Over 20 years, in populations aged ≥35 years, mortality reductions ranged from 109,863 in Australia to 467,297 in Germany, and corresponding life-years gained ranged from 640,870 to 2,803,783. Most survival gains accrued after the first decade. Under the modeled assumptions, the strategy was projected to be cost saving in all countries, with total savings ranging from $368.9 million in Australia to $46.5 billion in Germany, and dominant across payer and societal perspectives. Additional benefits included fewer hospital bed-days, lower productivity losses, and reduced CO2 emissions.Limitations Results depended on structural and epidemiologic assumptions, including screening uptake, disease progression, and risk equation recalibration. Uncertainty was assessed using deterministic rather than probabilistic sensitivity analysis.Conclusions Comprehensive CVRM screening, when embedded in preventive care pathways and linked to appropriate follow-up, may improve population health while generating substantial economic, societal, and environmental benefits.