Model Study Finds Combined Vascular Screening Most Cost-Effective for Cardiovascular Risk in Chinese Adults

Cardiovascular disease is the leading cause of death in China, yet few studies have used real-world data to systematically compare how well different screening strategies perform in terms of health benefits and cost-effectiveness. A new modeling study published in Archives of Public Health addressed that gap by comparing three screening approaches widely used in China against no screening at all, using electronic health records and cause-of-death surveillance data from the health management center of a tertiary hospital covering 2015 to 2024.

The three strategies examined were the China-PAR risk score, atherosclerotic cardiovascular disease (ASCVD) risk assessment, and ASCVD risk assessment combined with vascular assessment. The study population comprised 14,124 people aged 40 to 80 years who had completed the examination, questionnaire, and vascular testing required for risk prediction. Rather than fitting a separate disease model for each strategy, the researchers built a single covariate-adjusted three-state continuous-time Markov natural-history model, with states of no cardiovascular disease, a cardiovascular disease event treated as a composite absorbing endpoint, and non-cardiovascular death. Each screening strategy was represented as an intervention-allocation filter determining which individuals received lifestyle intervention and, where indicated, statin plus antihypertensive therapy.

Using per-person Markov cohort simulation over a 10-year horizon with 5% annual discounting, the team compared each strategy against no screening. Costs included screening, intervention, and cardiovascular disease event costs. Outcomes measured were incremental quality-adjusted life years (QALYs), the number of cardiovascular events prevented, the number needed to screen (NNS), the incremental cost-effectiveness ratio (ICER), and net monetary benefit, evaluated against a willingness-to-pay threshold of ¥90,000 per QALY.

The results showed that all three strategies were highly cost-effective relative to no screening. Incremental QALYs per person were 0.063 for the China-PAR score, 0.080 for ASCVD risk assessment, and 0.113 for the combined strategy of ASCVD risk assessment plus vascular assessment. The corresponding ICERs were ¥4,816, ¥9,314, and ¥12,089 per QALY, all far below the ¥90,000 threshold. The combined strategy prevented the most cardiovascular events, 636.73 in the cohort, and had the lowest number needed to screen to gain one QALY, at 8.8.

In the fully incremental analysis, the ASCVD risk assessment strategy alone was excluded by extended dominance, and the combined strategy remained cost-effective against the China-PAR strategy at ¥21,292 per QALY. At the willingness-to-pay threshold, the combined strategy had about a 99% probability of being the optimal option, and every sensitivity analysis kept all strategies well below ¥90,000 per QALY.

Age strongly shaped the benefit of screening. The incremental QALY of the combined strategy in people aged 55 to 80 was 0.224, about 4.4 times the 0.051 observed in the 40-to-54-year group. Sex also mattered: the China-PAR score modestly outperformed ASCVD risk assessment in women, with incremental QALYs of 0.037 versus 0.035, and in adults aged 55 to 80, with 0.160 versus 0.152.

The authors concluded that all three cardiovascular screening strategies were highly cost-effective relative to no screening, with the combined ASCVD and vascular assessment strategy the preferred option overall and especially in adults aged 55 to 80, while the China-PAR score may be favored in women. Importantly, because the three strategies shared a single natural-history model and differed only in intervention allocation, the differences in cost-effectiveness reflect the accuracy of risk classification rather than different disease trajectories.

The findings come with the caveats inherent to modeling work: the analysis drew on data from a single tertiary hospital health management center and simulated outcomes over 10 years rather than observing them directly. Probabilistic sensitivity analysis with 1,000 Monte Carlo iterations, one-way sensitivity analysis, scenario analyses, and subgroup analyses by age and sex were performed to test robustness. Within those limits, the study offers real-world evidence that combining vascular assessment with conventional risk scoring may deliver the greatest value in cardiovascular screening programs for middle-aged and older Chinese adults.

Subject of Research: Cost-effectiveness of three cardiovascular disease screening strategies in a Chinese health-examination population using a Markov model

Article Title: Comparing cardiovascular screening strategies in a health-examination population: a real-world markov model study

Article References: Chen, K., Yang, S., Yan, L., Li, Y., Zhu, X., Wang, J., & Yang, P. (2026). Comparing cardiovascular screening strategies in a health-examination population: a real-world markov model study. Archives of Public Health. https://doi.org/10.1186/s13690-026-02108-6

Image Credits: AI Generated

DOI: 10.1186/s13690-026-02108-6

Keywords: cardiovascular disease, screening strategies, cost-effectiveness, Markov model, China-PAR score, ASCVD risk assessment, vascular assessment, QALY, health examination, real-world data, number needed to screen, statin therapy