Comparative Effectiveness and Cost-Effectiveness of Computed Tomography Screening for Coronary Artery Calcium in Asymptomatic Individuals

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:58

Article

van Kempen, Bob J. H.^1,2  Spronk, Sandra^1,2  Koller, Michael T.³  Elias-Smale, Suzette E.^1,2  Fleischmann, Kirsten E.⁴  Ikram, M. Arfan^1,2  Krestin, Gabriel P.²  Hofman, Albert¹  Witteman, Jacqueline C. M.¹  Hunink, M. G. Myriam^1,2,5 

[1] Erasmus MC, Dept Epidemiol, NL-3015 GD Rotterdam, Netherlands

[2] Erasmus MC, Dept Radiol, NL-3015 GD Rotterdam, Netherlands

[3] Univ Basel Hosp, Inst Clin Epidemiol, CH-4031 Basel, Switzerland

[4] Univ Calif San Francisco, Sch Med, Dept Med, Div Cardiol, San Francisco, CA USA

[5] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA

关键词: coronary heart disease;    cost-effectiveness analysis;    CT coronary calcium;    CT screening;    primary prevention;   

DOI  :  10.1016/j.jacc.2011.05.056

来源: Elsevier

【 摘 要 】

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. (J Am Coll Cardiol 2011;58:1690-701) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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