Cost-effectiveness of coronary artery XXXX testing for coronary heart and @entity65 risk prediction to guide statin allocation: the Multi-Ethnic Study of @entity731 (MESA).

@entity1 @entity301 @entity7464 @entity71327 @entity700 @entity460 @entity731 @entity65 @entity165
BACKGROUND: The Multi-Ethnic Study of @entity731 (MESA) showed that the addition of coronary artery @entity460 ( @entity7464 ) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic @entity1 with LDL @entity165 levels <160 mg/dL. However, the cost-effectiveness of incorporating @entity7464 into treatment decision rules has yet to be clearly delineated. OBJECTIVE: To model the cost-effectiveness of @entity7464 for cardiovascular risk stratification in asymptomatic, intermediate risk @entity1 not taking a statin. Treatment based on @entity7464 was compared to (1) treatment of all intermediate-risk @entity1 , and (2) treatment on the basis of United States guidelines. METHODS: We developed a Markov model of first @entity301 ( @entity301 ) and @entity65 ( @entity65 ) events. We modeled statin treatment in intermediate risk @entity1 with @entity71327 and @entity7464 >= 100, with different intensities of statins based on the @entity7464 score. We compared these @entity7464 -based treatment strategies to a "treat all" strategy and to treatment according to the Adult Treatment Panel III (ATP III) guidelines. Clinical and economic outcomes were modeled over both five- and ten-year time horizons. Outcomes consisted of @entity301 and @entity65 events and Quality-Adjusted Life Years (QALYs). Sensitivity analyses considered the effect of higher event rates, different @entity7464 and statin costs, indirect costs, and re-scanning @entity1 with @entity700 . RESULTS: We project that it is both cost-saving and more effective to scan intermediate-risk @entity1 for @entity7464 and to treat those with @entity71327 , compared to treatment based on established risk-assessment guidelines. Treating @entity1 with @entity7464 >= 100 is also preferred to existing guidelines when we account for statin side effects and the disutility of statin use. CONCLUSION: Compared to the alternatives we assessed, @entity7464 testing is both effective and cost saving as a risk-stratification tool, particularly if there are adverse effects of long-term statin use. @entity7464 may enable providers to better tailor preventive therapy to @entity1 ' risks of @entity65 .
