Economical Aspects of High-Sensitivity C-Reactive Protein as Predictor of Coronary Heart Disease

Background/Objectives: Measurement of high-sensitivity C-reactive protein (hs-CRP) in addition to lipid fraction measurements has been shown to improve the prediction of increased cardiovascular risk significantly. Moreover, baseline concentrations of hs-CRP seem to modulate the effectiveness of two preventive therapies: aspirin and statins. We evaluated the cost effectiveness (CE) of two primary prevention strategies, including hs-CRP determination versus no testing of hs-CRP, in three European countries: France, Spain and Switzerland. Methods: Using a decision analytic model, we evaluated the costs and consequences of two prevention strategies, including screening with hs-CRP in addition to standard lipid screening compared with no measurement of CRP levels. We analysed a hypothetical cohort of 100,000 apparently healthy men in three age groups (35–44, 45–54 and 55–64 years). Individuals with hs-CRP levels >3 mg/l were administered either aspirin or statin according to their lipid levels. Each cohort was followed for 5 years. The analysis was performed from the societal perspective. Extensive sensitivity analysis was performed in order to test the robustness of our conclusions. Results: Prevention strategies that include CRP determinations in addition to standard lipid screening improve outcomes with modest increments or even a reduction in the total expenditures. The results depended on: (1) whether statins were used more restrictively or extensively; (2) the age of the cohort, and (3) the local incidence of cardiovascular disease. Sensitivity analysis performed on the variables ‘test price’ and ‘cost of cardiovascular events’ resulted in minimal changes of the CE ratios. Conclusions: In the primary prevention setting, determination of CRP blood levels in addition to lipid screening can help better target individuals at higher risk, identifying those who will profit the most from existing therapies. Screening with hs-CRP can improve outcomes and result in more cost-effective prevention strategies.