Coronary artery calcium score-guided statin therapy in intermediate-risk patients is cost-effective (<$50,000 per QALY) only if statins are costly or significantly affect quality of life.
Does measuring CAC score to guide statin therapy improve cost-effectiveness compared to treating all intermediate-risk patients?
CAC testing to guide statin therapy in intermediate-risk patients is generally not cost-effective compared to a 'treat all' strategy unless statins are expensive or significantly reduce quality of life.
BACKGROUND: The coronary artery calcium (CAC) score predicts future coronary heart disease (CHD) events and could be used to guide primary prevention interventions, but CAC measurement has costs and exposes patients to low-dose radiation. METHODS AND RESULTS: We estimated the cost-effectiveness of measuring CAC and prescribing statin therapy based on the resulting score under a range of assumptions using an established model enhanced with CAC distribution and risk estimates from the Multi-Ethnic Study of Atherosclerosis. Ten years of statin treatment for 10, 000 55-year-old women with high cholesterol (10-year CHD risk, 7. 5%) was projected to prevent 32 myocardial infarctions, cause 70 cases of statin-induced myopathy, and add 1108 years to total life expectancy. Measuring CAC and targeting statin treatment to the 2500 women with CAC>0 would provide 45% of the benefit (+501 life-years), but CAC measurement would cost 2. 25 million and cause 9 radiation-induced cancers. Treat all was preferable to CAC screening in this scenario and across a broad range of other scenarios (CHD risk, 2. 5%-15%) when statin assumptions were favorable (0. 13 per pill and no quality of life penalty). When statin assumptions were less favorable (1. 00 per pill and disutility=0. 00384), CAC screening with statin treatment for persons with CAC>0 was cost-effective (100 or >300) were generally not cost-effective. CONCLUSIONS: CAC testing in intermediate risk patients can be cost-effective but only if statins are costly or significantly affect quality of life.
Pletcher et al. (Sat,) conducted a other in High cholesterol (n=10,000). Coronary artery calcium (CAC) score-guided statin therapy vs. Treat all with statin therapy was evaluated on Cost-effectiveness (cost per quality-adjusted life-year). Coronary artery calcium score-guided statin therapy in intermediate-risk patients is cost-effective (<$50,000 per QALY) only if statins are costly or significantly affect quality of life.
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