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https://hdl.handle.net/2440/131423
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Type: | Journal article |
Title: | Cost-effectiveness of coronary artery calcium scoring in people with a family history of coronary disease |
Author: | Venkataraman, P. Kawakami, H. Huynh, Q. Mitchell, G. Nicholls, S.J. Stanton, T. Tonkin, A. Watts, G.F. Marwick, T.H. |
Citation: | JACC: Cardiovascular Imaging, 2021; 14(6):1206-1217 |
Publisher: | Elsevier |
Issue Date: | 2021 |
ISSN: | 1936-878X 1876-7591 |
Statement of Responsibility: | Prasanna Venkataraman, Hiroshi Kawakami, Quan Huynh,Geoffrey Mitchell, Stephen J.Nicholls, Tony Stanton ... et al. |
Abstract: | Background The use of coronary artery calcium scoring (CAC) to guide primary prevention statin therapy in those with a family history of premature coronary artery disease (FHCAD) is inconsistently recommended in guidelines, and usually not reimbursed by insurance. We assessed the cost-effectiveness of CAC compared with traditional risk factor-based prediction alone in those with an FHCAD. Methods: A microsimulation model was constructed in TreeAge Healthcare Pro using data from 1,083 participants in the CAUGHT-CAD (Coronary Artery Calcium Score: Use to Guide Management of HerediTary Coronary Artery Disease) trial. Outcomes assessed were quality-adjusted life years (QALYs): cost-effectiveness was assessed over a 15-year time horizon from the perspective of the US health care sector using real-world statin prescribing, accounting for the effect of knowledge of subclinical disease on adherence to guideline-directed therapies. Costs were assessed in 2020 USD, with discounting undertaken at 3%. Results: Statins were indicated in 45% of the cohort using the CAC strategy and 27% using American College of Cardiology/American Heart Association (2019) treatment strategies. Compared with applying a statin treatment threshold of 7.5%, the CAC strategy was more costly ($145) and more effective (0.0097 QALY) with an incremental cost-effective ratio (ICER) of $15,014/QALY. CAC ICER was driven by CAC acquisition and statin prescription cost and improved with certain patient subgroups: male, age >60 years, and 10-year risk pooled cohort equation risk ≥7.5%. CAC scanning of low-risk patients (10-year risk <5%) or those 40 to 50 years of age was not cost-effective. Conclusion: Systematic CAC screening and treatment of those with FHCAD and subclinical disease was more cost-effective than management using statin treatment thresholds, in the US health care system. |
Keywords: | CAUGHT-CAD investigators |
Rights: | © 2021 by The American Collage of Cardiology Foundation |
DOI: | 10.1016/j.jcmg.2020.11.008 |
Published version: | http://dx.doi.org/10.1016/j.jcmg.2020.11.008 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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