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Published on: August 9, 2024
A multimarker approach for the prediction of coronary artery disease: cost-effectiveness analysis
Dragana Lakić1, Nataša Bogavac-Stanojević, Zorana Jelić-Ivanović
1Institute for Social Pharmacy and Pharmacy Legislation, Faculty of Pharmacy, University of Belgrade, Serbia. dlakic@pharmacy.bg.ac.rs
Insights
A multi-marker approach, including oxidative stress markers, shows superior and cost-effective prediction of coronary artery disease (CAD) compared to traditional risk scores. This strategy enhances patient stratification for better CAD management.
Area of Science:
- Cardiology
- Biomarkers
- Health Economics
Background:
- Coronary artery disease (CAD) is a leading cause of mortality and a significant economic burden.
- Current risk prediction models for CAD may lack optimal discriminative ability.
Purpose of the Study:
- To evaluate the discriminative ability and cost-effectiveness of a multi-marker approach for predicting CAD.
- To compare novel marker strategies against the established Framingham risk score (FRS).
Main Methods:
- A decision model was employed to assess costs, accuracy, and cost-effectiveness.
- Various markers including lipid, inflammatory, and oxidative stress markers were evaluated.
- Receiver operating characteristic (ROC) curves were used to determine predictive probabilities in 188 CAD patients and 197 controls.
Main Results:
- The best-case model (FRS, superoxide dismutase [SOD], and superoxide anion [O(2)(-)]) achieved an Area Under the Curve (AUC) of 0.924.
- FRS plus SOD yielded an AUC of 0.906.
- Strategies incorporating oxidative stress/antioxidative defense markers demonstrated greater cost-effectiveness than those using lipid or inflammatory markers.
Conclusions:
- A multi-marker strategy is feasible and effective for CAD screening.
- Integrating oxidative stress/antioxidative defense markers into clinical practice is recommended for convenience and cost-effectiveness.
Objectives:
Coronary artery disease (CAD), as the leading cause of death, poses a huge economic burden on health-care systems. We used a multi-marker approach to explore discriminative abilities of several lipid, inflammatory, and oxidative stress/antioxidative defense markers as CAD predictors. We assessed their cost-effectiveness compared with the Framingham risk score (FRS).
Methods:
Using a decision model, we evaluated the costs, accuracy, and cost-effectiveness of each model. The FRS was used as the baseline model. Other models were formed with the consecutive addition of selected markers: apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), apolipoprotein (a) [apo(a)] isoform, lipoprotein (a), high-sensitivity C-reactive protein, malondialdehyde, superoxide dismutase (SOD), sulfhydryl, and superoxide anion (O(2) (-) ). A best-case model was formed from a combination of diagnostic markers to yield the best patient stratification algorithm. All models were assessed by their predictive probabilities using receiver operating characteristic curves. To accomplish our goals, we recruited 188 CAD patients (verified by coronary angiography) and 197 asymptomatic CAD-free subjects for comparison. The analysis was performed from a third-party payer perspective.
Results:
Only two strategies had outstanding discriminative abilities: the best-case model (FRS, SOD, and O(2) (-) ) and FRS plus SOD with area under the curve (AUC) values of 0.924 and 0.906, respectively. The cost-effectiveness ratio varied between €593 per AUC for the baseline model to €2425 per AUC for FRS plus apo(a) isoform. Strategies involving oxidative stress/antioxidative defense markers were more cost-effective than strategies involving lipid or inflammatory markers. All results were robust.
Conclusion:
Our results support the feasibility of a multimarker approach for CAD screening. The introduction of oxidative stress/antioxidative defense markers in the clinical laboratory would be convenient and cost-effective.
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