TY - JOUR
T1 - Comparing the cost-effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population
AU - van Kempen, Bob
AU - Ferket, BS
AU - Steyerberg, Ewout
AU - Max, W
AU - Hunink, Myriam
AU - Fleischmann, KE
PY - 2016
Y1 - 2016
N2 - Background: High sensitivity CRP (hsCRP), coronary artery calcification on CT (CT calcium), carotid artery intima media thickness on ultrasound (cIMT) and ankle-brachial index (ABI) improve prediction of cardiovascular disease (CVD) risk, but the benefit of screening with these novel risk markers in the U.S. population is unclear. Methods and results: A microsimulation model evaluating lifelong cost-effectiveness for individuals aged 40-85 at intermediate risk of CVD, using 2003-2004 NHANES-III (N= 3736), Framingham Heart Study, U.S. Vital Statistics, meta-analyses of independent predictive effects of the four novel risk markers and treatment effects was constructed. Using both an intention-to-treat (assumes adherence <100% and incorporates disutility from taking daily medications) and an as-treated (100% adherence and no disutility) analysis, quality adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER in $/QALY gained) of screening with hsCRP, CT coronary calcium, cIMT and ABI were established compared with current practice, full adherence to current guidelines, and ubiquitous statin therapy. In the intention-to-treat analysis in men, screening with CT calcium was cost effective ($ 32,900/QALY) compared with current practice. In women, screening with hsCRP was cost effective ($ 32,467/QALY). In the as-treated analysis, statin therapy was both more effective and less costly than all other strategies for both men and women. Conclusions: When a substantial disutility from taking daily medication is assumed, screening men with CT coronary calcium is likely to be cost-effective whereas screening with hsCRP has value in women. The individual perceived disutility for taking daily medication should play a key role in the decision. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
AB - Background: High sensitivity CRP (hsCRP), coronary artery calcification on CT (CT calcium), carotid artery intima media thickness on ultrasound (cIMT) and ankle-brachial index (ABI) improve prediction of cardiovascular disease (CVD) risk, but the benefit of screening with these novel risk markers in the U.S. population is unclear. Methods and results: A microsimulation model evaluating lifelong cost-effectiveness for individuals aged 40-85 at intermediate risk of CVD, using 2003-2004 NHANES-III (N= 3736), Framingham Heart Study, U.S. Vital Statistics, meta-analyses of independent predictive effects of the four novel risk markers and treatment effects was constructed. Using both an intention-to-treat (assumes adherence <100% and incorporates disutility from taking daily medications) and an as-treated (100% adherence and no disutility) analysis, quality adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER in $/QALY gained) of screening with hsCRP, CT coronary calcium, cIMT and ABI were established compared with current practice, full adherence to current guidelines, and ubiquitous statin therapy. In the intention-to-treat analysis in men, screening with CT calcium was cost effective ($ 32,900/QALY) compared with current practice. In women, screening with hsCRP was cost effective ($ 32,467/QALY). In the as-treated analysis, statin therapy was both more effective and less costly than all other strategies for both men and women. Conclusions: When a substantial disutility from taking daily medication is assumed, screening men with CT coronary calcium is likely to be cost-effective whereas screening with hsCRP has value in women. The individual perceived disutility for taking daily medication should play a key role in the decision. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
U2 - 10.1016/j.ijcard.2015.10.171
DO - 10.1016/j.ijcard.2015.10.171
M3 - Article
C2 - 26547049
SN - 0167-5273
VL - 203
SP - 422
EP - 431
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -