Canadian Cost-Effectiveness of Coronary Artery Calcium Screening Based on the Multi-Ethnic Study of Atherosclerosis.

Autor:	Qureshi H; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada., Kaul P; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada., Dover DC; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada., Blaha MJ; Department of Medicine, Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA., Bellows BK; Department of Medicine, Columbia University, New York, New York, USA., Mancini GBJ; Centre for Cardiovascular Innovation & Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2024 Mar 06; Vol. 3 (4), pp. 100886. Date of Electronic Publication: 2024 Mar 06 (Print Publication: 2024).
DOI:	10.1016/j.jacadv.2024.100886
Abstrakt:	Background: Cost-effectiveness of testing for coronary artery calcium (CAC) relative to other treatment strategies is not established in Canada. Objectives: The purpose of this study was to evaluate the cost-effectiveness of using CAC score-guided statin treatment compared with universal statin therapy among intermediate-risk, primary prevention patients eligible for statins. Methods: A state transition, microsimulation model used data from Canadian sources and the Multi-Ethnic Study of Atherosclerosis to simulate clinical and economic consequences of cardiovascular disease from a Canadian publicly funded health care system perspective. In the CAC score-guided treatment arm, statins were started when CAC ≥1. Outcome of interest was the incremental cost-effectiveness ratio at 5 and 10 years; an incremental cost-effectiveness ratio <$50,000 per quality-adjusted life year (QALY) gained was considered cost-effective. Sensitivity analyses examined uncertainty in model parameters. Results: Compared with universal statin treatment at 5 and 10 years, CAC score-guided statin treatment was projected to increase mean costs by $326 (95% CI: $325-$326) and $172 (95% CI: $169-$175), increase mean QALYs by 0.01 (95% CI: 0.01-0.01) and 0.02 (95% CI: 0.02-0.02), and cost $54,492 (95% CI: $52,342-$56,816) and $8,118 (95% CI: $7,968-$8,279) per QALY gained, respectively. The model was most sensitive to statin cost, CAC testing cost, adherence to statin monitoring, and disutility associated with daily statin use. At 5 years, CAC score-guided statin treatment was cost-effective when CAC test costs ranged from $80 to $160 in different scenarios. Conclusions: CAC score-guided statin initiation in comparison to universal statin treatment was borderline cost-neutral at 5 years and cost-effective at 10 years in statin-eligible Canadian patients at intermediate cardiovascular disease risk. Competing Interests: Funding was provided by the CardioRisk Clinic Grant/Vancouver Hospital Foundation. MESA was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the 10.13039/100000050National Heart, Lung, and Blood Institute (Bethesda, Maryland), and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the 10.13039/100006108National Center for Advancing Translational Sciences (NCATS) (Bethesda, Maryland). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2024 The Authors.)
Databáze:	MEDLINE
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