Focused Issue: CAC Imaging
State-of-the-Art Paper
Implications of Coronary Artery Calcium Testing for Treatment Decisions Among Statin Candidates According to the ACC/AHA Cholesterol Management Guidelines: A Cost-Effectiveness Analysis

https://doi.org/10.1016/j.jcmg.2017.04.014Get rights and content
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Abstract

This review evaluates the cost-effectiveness of using coronary artery calcium (CAC) to guide long-term statin therapy compared with treating all patients eligible for statins according to 2013 American College of Cardiology/American Heart Association cholesterol management guidelines for atherosclerotic cardiovascular disease. The authors used a microsimulation model to compare costs and effectiveness from a societal perspective over a lifetime horizon. Both strategies resulted in similar costs and quality-adjusted life years (QALYs). CAC resulted in increased costs (+$81) and near-equal QALY (+0.01) for an incremental cost-effectiveness ratio of $8,100/QALY compared with the treat-all strategy. For 10,000 patients, the treat-all strategy would theoretically avert 21 atherosclerotic cardiovascular disease events, but would add 47,294 person-years of statins. With CAC costs <$100, and higher cost and/or disutility associated with statin therapy, CAC strategy was favored. These findings suggest the economic value of both approaches were similar. Clinicians should account for individual preferences in context of shared decision making when choosing the most appropriate strategy to guide statin decisions.

Key Words

atherosclerosis
CAC
cholesterol
cost-effectiveness analysis
risk assessment
statins

Abbreviations and Acronyms

ACC
American College of Cardiology
AHA
American Heart Association
ASCVD
atherosclerotic cardiovascular disease
CAC
coronary artery calcium
CHD
coronary heart disease
CI
confidence interval
ICER
incremental cost-effectiveness ratio
QALY
quality-adjusted life year

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This work was supported by an educational grant from the Johns Hopkins School of Nursing. Dr. Krumholz has research agreements with Medtronic and Johnson & Johnson through his institution; is a member of the scientific advisory board for UnitedHealth; is on the physician advisory board of Aetna; and is the founder of Hugo. Dr. Nasir is on the advisory board for Quest Diagnostic; and is a consultant for Regeneron. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William S. Weintraub, MD, served as the Guest Editor for this paper.