■在加拿大尚未建立相对于其他治疗策略的冠状动脉钙(CAC)测试的成本效益。
■本研究的目的是评估使用CAC评分指导的他汀类药物治疗与通用他汀类药物治疗的成本效益,符合他汀类药物的一级预防患者。
■状态转换,微观模拟模型使用来自加拿大来源的数据和多种族动脉粥样硬化研究,从加拿大公共资助的医疗保健系统的角度模拟心血管疾病的临床和经济后果。在CAC评分指导的治疗臂中,当CAC≥1时开始他汀类药物。感兴趣的结果是5年和10年的增量成本效益比;每个质量调整生命年(QALY)获得的增量成本效益比<50,000美元被认为具有成本效益。敏感性分析检查了模型参数的不确定性。
■与5年和10年时的通用他汀类药物治疗相比,CAC评分指导的他汀类药物治疗预计会使平均成本增加326美元(95%CI:325-326美元)和172美元(95%CI:169-175美元),平均QALY增加0.01(95%CI:0.01-0.01)和0.02(95%CI:0.02-0.02),成本为$54,492(95%CI:$52,342-$56,816)和$8,118(95%CI:$7,968-$8,279),分别。该模型对他汀类药物成本最敏感,CAC测试成本,坚持他汀类药物监测,和与每日他汀类药物使用相关的无效性。在5年,在不同情况下,当CAC测试费用从80美元到160美元不等时,CAC评分指导的他汀类药物治疗具有成本效益。
■在符合他汀类药物资格的中度心血管疾病风险的加拿大患者中,与通用他汀类药物治疗相比,CAC评分指导的他汀类药物开始治疗在5年时成本中性,在10年时具有成本效益。
UNASSIGNED: Cost-effectiveness of testing for coronary artery calcium (CAC) relative to other treatment strategies is not established in Canada.
UNASSIGNED: The purpose of this study was to evaluate the cost-effectiveness of using CAC score-guided statin treatment compared with universal statin therapy among intermediate-risk, primary prevention patients eligible for
statins.
UNASSIGNED: A state transition, microsimulation model used data from Canadian sources and the Multi-Ethnic Study of Atherosclerosis to simulate clinical and economic consequences of cardiovascular disease from a Canadian publicly funded health care system perspective. In the CAC score-guided treatment arm,
statins were started when CAC ≥1. Outcome of interest was the incremental cost-effectiveness ratio at 5 and 10 years; an incremental cost-effectiveness ratio <$50,000 per quality-adjusted life year (QALY) gained was considered cost-effective. Sensitivity analyses examined uncertainty in model parameters.
UNASSIGNED: Compared with universal statin treatment at 5 and 10 years, CAC score-guided statin treatment was projected to increase mean costs by $326 (95% CI: $325-$326) and $172 (95% CI: $169-$175), increase mean QALYs by 0.01 (95% CI: 0.01-0.01) and 0.02 (95% CI: 0.02-0.02), and cost $54,492 (95% CI: $52,342-$56,816) and $8,118 (95% CI: $7,968-$8,279) per QALY gained, respectively. The model was most sensitive to statin cost, CAC testing cost, adherence to statin monitoring, and disutility associated with daily statin use. At 5 years, CAC score-guided statin treatment was cost-effective when CAC test costs ranged from $80 to $160 in different scenarios.
UNASSIGNED: CAC score-guided statin initiation in comparison to universal statin treatment was borderline cost-neutral at 5 years and cost-effective at 10 years in statin-eligible Canadian patients at intermediate cardiovascular disease risk.