Key result
Troponin I-guided screening reduces 10-year cardiovascular events with a number needed to screen of ~191.
Why the study?
The cost-effectiveness of using high-sensitivity troponin-I to assess cardiovascular disease risk in a general population had not been established.
Does a high-sensitivity troponin-I screening strategy prevent cardiovascular events and prove cost-effective in an asymptomatic general population?
Does a high-sensitivity troponin-I screening strategy prevent cardiovascular events and prove cost-effective in an asymptomatic general population?
Number Needed to Treat: 191 (95% CI 187–215)
Absolute Event Rate: 5.06% vs 5.58%
Absolute Risk Reduction: 0.5%
Number Needed to Treat: 191
A biomarker-guided screening approach using high-sensitivity troponin-I to identify and treat high-risk individuals in primary prevention is projected to be highly cost-effective or cost-saving.
hsTnI-guided screening may prove cost-effective in modeled populations; leaves open prospective RCT confirmation before practice change.
AIMS: To estimate the cost-effectiveness of using the cardiac specific marker high-sensitivity troponin-I (hsTnI) for assessing cardiovascular disease (CVD) risk in a general population. METHODS AND RESULTS: A discrete-event simulation model was developed from a societal perspective of a low-risk (Germany) and a high-risk (Kazakhstan) country. The model compared a Screen&Prevent strategy guided by hsTnI against a do-nothing strategy. Risk functions were derived from published data of a prospective cohort study [Nord-Trøndelag Health (HUNT) Study]. The model assessed the number of CVD events and deaths, healthy life years, direct and indirect costs in PPP 2018 Dollar, and quality-adjusted life years (QALY) over a time horizon of 10 years. Screen&Prevent reduced the number of CVD events per 1000 subjects by 5.1 and 5.0, equal to a number-needed-to-screen of 195 and 191 in Kazakhstan and Germany. Screen&Prevent was cost saving in Kazakhstan and cost-effective in Germany with an incremental-cost-effectiveness ratio of $6755 ($2294; $24 054) per QALY gained at an opportunity-cost based willingness-to-pay threshold of $27 373. Varying input variables in univariate and probabilistic sensitivity analyses confirmed the robustness of the analysis. CONCLUSION: Assessing the cardiovascular risk with hsTnI in a general population and subsequently referring those at high risk to preventive means would very likely be cost-effective or cost-saving by avoiding CVD events and associated direct and indirect costs. This conclusion is retained even if only the direct costs or only the costs for screening and prevention are considered. Future studies should evaluate the incremental cost-effectiveness of hsTnI-guided assessment strategies against established risk algorithms.
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Jülicher et al. (2021) studied Cardiovascular disease risk in an asymptomatic population (n=25,000). Screen&Prevent strategy guided by high-sensitivity troponin-I (hsTnI) vs. Do-nothing strategy (no screening, no prevention) was evaluated on Cardiovascular events over 10 years (Germany simulation) (Number needed to screen 191, 95% CI 187-215). A high-sensitivity troponin-I guided screening and prevention strategy reduced cardiovascular events over 10 years with a number needed to screen of 195 (Kazakhstan) and 191 (Germany), proving to be cost-saving or cost-effective.
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