Author + information
- Jonathan Honga,b,
- Ron Blanksteina,b,
- Michael Blahaa,b,
- Roger Blumenthala,b,
- Alejandro Arrietaa,b,
- William Padulaa,b,
- Harlan Krumholza,b and
- Khurram Nasira,b
Background: We evaluated cost-effectiveness of using coronary artery calcium (CAC) to guide treatment strategies in patients eligible for statins according to the 2013 ACC/AHA cholesterol management guidelines.
Methods: We compared two treatment strategies: (1) “Guidelines,” statin therapy as per the guidelines; or (2) using “CAC” to risk stratify statin eligible candidates (CAC=0 no treatment, CAC>0 statin treatment). We implemented a Markov micro-simulation model incorporating patient heterogeneity to compare costs and effectiveness over a 10-year period. Cardiovascular (CVD) event risk functions were derived from Multi-Ethnic Study of Atherosclerosis study. The base case was defined by CAC cost of $100, statin cost of $200/year, and a disutility with statin therapy.
Results: Both strategies resulted in similar costs and quality-adjusted life years (QALYs). CAC resulted in reduced costs (-$84) and near-equal QALYs (-0.002). Guidelines averted an additional 20 CVD events, but added 17,705 person-years of statin therapy compared to CAC in 10,000 patients over a 10-year period. The model was sensitive to changes in annual cost of statins (< $100/year, Guidelines was dominant; > $250/year, CAC was dominant). When there was a higher disutility with statin then CAC was the dominant strategy.
Conclusions: The economic value of both treatment strategies was similar suggesting shared decision-making can choose the best strategy based on individual preferences among potential statin candidates.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovations in Cardiovascular Risk Assessment and Reduction
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1235-061
- 2017 American College of Cardiology Foundation