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Int J Cardiol ; 203: 422-31, 2016 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-26547049

RESUMO

BACKGROUND: High sensitivity CRP (hsCRP), coronary artery calcification on CT (CT calcium), carotid artery intima media thickness on ultrasound (cIMT) and ankle-brachial index (ABI) improve prediction of cardiovascular disease (CVD) risk, but the benefit of screening with these novel risk markers in the U.S. population is unclear. METHODS AND RESULTS: A microsimulation model evaluating lifelong cost-effectiveness for individuals aged 40-85 at intermediate risk of CVD, using 2003-2004 NHANES-III (N=3736), Framingham Heart Study, U.S. Vital Statistics, meta-analyses of independent predictive effects of the four novel risk markers and treatment effects was constructed. Using both an intention-to-treat (assumes adherence <100% and incorporates disutility from taking daily medications) and an as-treated (100% adherence and no disutility) analysis, quality adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER in $/QALY gained) of screening with hsCRP, CT coronary calcium, cIMT and ABI were established compared with current practice, full adherence to current guidelines, and ubiquitous statin therapy. In the intention-to-treat analysis in men, screening with CT calcium was cost effective ($32,900/QALY) compared with current practice. In women, screening with hsCRP was cost effective ($32,467/QALY). In the as-treated analysis, statin therapy was both more effective and less costly than all other strategies for both men and women. CONCLUSIONS: When a substantial disutility from taking daily medication is assumed, screening men with CT coronary calcium is likely to be cost-effective whereas screening with hsCRP has value in women. The individual perceived disutility for taking daily medication should play a key role in the decision.


Assuntos
Índice Tornozelo-Braço , Proteína C-Reativa/economia , Calcinose/diagnóstico , Calcinose/economia , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/economia , Análise Custo-Benefício , Índice Tornozelo-Braço/economia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Calcinose/prevenção & controle , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Espessura Intima-Media Carotídea/economia , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/prevenção & controle , Análise Custo-Benefício/economia , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Valor Preditivo dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Estados Unidos
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