Abstract | OBJECTIVES: The aim of this study was to assess the (cost-) effectiveness of screening asymptomatic individuals at intermediate risk of coronary heart disease (CHD) for coronary artery calcium with computed tomography (CT). BACKGROUND: Coronary artery calcium on CT improves prediction of CHD. METHODS: A Markov model was developed on the basis of the Rotterdam Study. Four strategies were evaluated: 1) current practice; 2) current prevention guidelines for cardiovascular disease; 3) CT screening for coronary calcium; and 4) statin therapy for all individuals. Asymptomatic individuals at intermediate risk of CHD were simulated over their remaining lifetime. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios were calculated. RESULTS: In men, CT screening was more effective and more costly than the other 3 strategies (CT vs. current practice: +0.13 QALY [95% confidence interval (CI): 0.01 to 0.26], +$4,676 [95% CI: $3,126 to $6,339]; CT vs. statin therapy: +0.04 QALY [95% CI: -0.02 to 0.13], +$1,951 [95% CI: $1,170 to $2,754]; and CT vs. current guidelines: +0.02 QALY [95% CI: -0.04 to 0.09], +$44 [95% CI: -$441 to $486]). The incremental cost-effectiveness ratio of CT calcium screening was $48,800/QALY gained. In women, CT screening was more effective and more costly than current practice (+0.13 QALY [95% CI: 0.02 to 0.28], +$4,663 [95% CI: $3,120 to $6,277]) and statin therapy (+0.03 QALY [95% CI: -0.03 to 0.12], +$2,273 [95% CI: $1,475 to $3,109]). However, implementing current guidelines was more effective compared with CT screening (+0.02 QALY [95% CI: -0.03 to 0.07]), only a little more expensive (+$297 [95% CI: -$8 to $633]), and had a lower cost per additional QALY ($33,072/QALY vs. $35,869/QALY). Sensitivity analysis demonstrated robustness of results in women but considerable uncertainty in men. CONCLUSIONS: Screening for coronary artery calcium with CT in individuals at intermediate risk of CHD is probably cost-effective in men but is unlikely to be cost-effective in women.
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Authors | Bob J H van Kempen, Sandra Spronk, Michael T Koller, Suzette E Elias-Smale, Kirsten E Fleischmann, M Arfan Ikram, Gabriel P Krestin, Albert Hofman, Jacqueline C M Witteman, M G Myriam Hunink |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 58
Issue 16
Pg. 1690-701
(Oct 11 2011)
ISSN: 1558-3597 [Electronic] United States |
PMID | 21982314
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Aged
- Calcium
(metabolism)
- Comparative Effectiveness Research
- Coronary Artery Disease
(diagnosis)
- Coronary Disease
(diagnosis)
- Coronary Vessels
(metabolism)
- Cost-Benefit Analysis
- Female
- Health Care Costs
- Humans
- Male
- Markov Chains
- Mass Screening
(economics)
- Quality of Life
- Risk
- Sex Factors
- Stroke
(diagnosis)
- Tomography, X-Ray Computed
(economics, methods)
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