Implications of Coronary Artery Calcium Testing for Treatment Decisions Among Statin Candidates According to the ACC/AHA Cholesterol Management Guidelines: A Cost-Effectiveness Analysis

Jonathan C. Hong, Ron Blankstein, Leslee J. Shaw, William V. Padula, Alejandro Arrieta, Jonathan A. Fialkow, Roger S. Blumenthal, Michael J. Blaha, Harlan M. Krumholz, Khurram Nasir

Research output: Contribution to journalReview article

30 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)938-952
Number of pages15
JournalJACC: Cardiovascular Imaging
Volume10
Issue number8
DOIs
StatePublished - Aug 2017

Keywords

  • CAC
  • atherosclerosis
  • cholesterol
  • cost-effectiveness analysis
  • risk assessment
  • statins

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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