Author + information
- Received April 6, 2017
- Revision received April 19, 2017
- Accepted April 20, 2017
- Published online August 7, 2017.
- Jonathan C. Hong, MD, MHSa,b,
- Ron Blankstein, MDc,
- Leslee J. Shaw, PhDd,
- William V. Padula, PhD, MSa,b,
- Alejandro Arrieta, PhDe,
- Jonathan A. Fialkow, MDf,
- Roger S. Blumenthal, MDg,
- Michael J. Blaha, MD, MPHg,
- Harlan M. Krumholz, MD, SMh and
- Khurram Nasir, MD, MPHf,g,i,∗ ()
- aDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- bJohns Hopkins School of Nursing, Baltimore, Maryland
- cDepartment of Medicine and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- dEmory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
- eDepartment of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
- fMiami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
- gThe Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
- hCenter for Outcomes Research and Evaluation, Yale-New Haven Hospital, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- iCenter for Health Care Advancement and Outcomes, Baptist Health South Florida, Miami, Florida
- ↵∗Address for correspondence:
Dr. Khurram Nasir, Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, 1500 San Remo Avenue, Suite 340, Coral Gables, Florida 33139.
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.
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.
- Received April 6, 2017.
- Revision received April 19, 2017.
- Accepted April 20, 2017.
- 2017 American College of Cardiology Foundation