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Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men

Julia E H Nolte1, Till Neumann2, Jennifer M Manne3

  • 1Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.

European Journal of Preventive Cardiology
|March 30, 2013
PubMed

Insights

Cardiac screening for HIV-positive men is clinically beneficial and cost-effective. Strategies like stress testing and CCTA offer good value, comparable to existing HIV care interventions.

Area of Science:

  • Cardiology
  • Public Health
  • Health Economics

Background:

  • HIV infection significantly increases the risk of coronary artery disease (CAD).
  • Evaluating cost-effective screening strategies for CAD in HIV-positive men is crucial.

Purpose of the Study:

  • To assess the cost-effectiveness of different cardiac screening strategies for HIV-infected men at intermediate or higher risk of CAD.
  • To compare no screening versus stress testing and coronary computed tomography angiography (CCTA)-based screening approaches.

Main Methods:

  • A lifetime microsimulation model was developed to simulate CAD incidence and progression in HIV-infected men.
  • Input parameters were derived from HIV cohort studies and existing literature.
  • Compared strategies included no screening, stress testing, and CCTA, with varying intervention protocols (medication vs. percutaneous coronary intervention).

Main Results:

  • CCTA + medication strategy yielded the most quality-adjusted life days (19) per patient with an incremental cost-effectiveness ratio (ICER) of €34,887/QALY.
  • Screening at higher risk thresholds and repeated screening (stress testing + medication every 5 years) improved cost-effectiveness.
  • At a willingness-to-pay threshold of €83,000/QALY, implementing any CAD screening demonstrated a 75-95% probability of being cost-effective.

Conclusions:

  • Cardiac screening for CAD in HIV-positive men is clinically beneficial.
  • The cost-effectiveness ratios of these screening strategies are comparable to other accepted interventions within HIV care.
  • Implementing CAD screening for at-risk HIV-positive men represents a valuable healthcare investment.
Abstract

Keywords:
Coronary heart diseaseHIVMarkov modelcost-effectivenessprevention

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