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Who needs laboratories and who needs statins?: comparative and cost-effectiveness analyses of non-laboratory-based,
Ankur Pandya1, Milton C Weinstein, Joshua A Salomon
1Department of Public Health, Weill Cornell Medical College, New York, NY.
Insights
Non-laboratory cardiovascular disease (CVD) risk assessment is effective for primary prevention. Staged screening can reduce lab testing by 25-75% while maintaining predictive power comparable to traditional methods.
Area of Science:
- Cardiovascular Disease Research
- Preventive Medicine
- Health Economics
Background:
- Optimal screening algorithms for cardiovascular disease (CVD) risk factors lack consensus.
- Early detection and treatment of CVD risk factors yield significant clinical benefits.
- This study evaluates staged laboratory-based and non-laboratory-based CVD risk assessment strategies.
Purpose of the Study:
- To compare the cost-effectiveness of different CVD risk assessment algorithms.
- To evaluate laboratory-based versus non-laboratory-based screening approaches.
- To assess staged versus single-stage screening strategies for CVD risk.
Main Methods:
- Utilized receiver operating characteristic (ROC) curve analysis and cost-effectiveness modeling.
- Compared Framingham risk scores (laboratory-based) with non-laboratory and staged approaches.
- Employed microsimulation modeling on data from 5998 adults (Third National Health and Nutrition Examination Survey) with 10-year CVD death as the outcome.
Main Results:
- ROC curve analysis showed comparable predictive power between multistage and Framingham-based approaches (AUC 0.774-0.780 men, 0.812-0.834 women).
- Multistage strategies demonstrated cost-effectiveness with incremental cost-effectiveness ratios (ICERs) of $52,000/QALY (men) and $83,000/QALY (women).
- Single-stage/Framingham strategies were dominated or had ICERs >$300,000/QALY compared to non-laboratory and multistage approaches.
Conclusions:
- Non-laboratory CVD risk assessment is valuable for primary prevention, either alone or as part of a multistage strategy.
- Cost-effective multistage screening can reduce laboratory testing by 25-75% with predictive power similar to Framingham risk scores.
- Staged screening offers a viable, cost-effective alternative to traditional laboratory-based CVD risk assessment.
Background:
Early detection and treatment of cardiovascular disease (CVD) risk factors produces significant clinical benefits, but no consensus exists on optimal screening algorithms. This study aimed to evaluate the comparative and cost-effectiveness of staged laboratory-based and non-laboratory-based total CVD risk assessment.
Methods And Results:
We used receiver operating characteristic curve and cost-effectiveness modeling methods to compare strategies with and without laboratory components and used single-stage and multistage algorithms, including approaches based on Framingham risk scores (laboratory-based assessments for all individuals). Analyses were conducted using data from 5998 adults in the Third National Health and Nutrition Examination Survey without history of CVD using 10-year CVD death as the main outcome. A microsimulation model projected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios for 60 Framingham-based, non-laboratory-based, and staged screening approaches. Across strategies, the area under the receiver operating characteristic curve was 0.774 to 0.780 in men and 0.812 to 0.834 in women. There were no statistically significant differences in area under the receiver operating characteristic curve between multistage and Framingham-based approaches. In cost-effectiveness analyses, multistage strategies had incremental cost-effectiveness ratios of $52,000/QALY and $83,000/QALY for men and women, respectively. Single-stage/Framingham-based strategies were dominated (higher cost and lower QALYs) or had unattractive incremental cost-effectiveness ratios (>$300,000/QALY) compared with single-stage/non-laboratory-based and multistage approaches.
Conclusions:
Non-laboratory-based CVD risk assessment can be useful in primary CVD prevention as a substitute for laboratory-based assessments or as the initial component of a multistage approach. Cost-effective multistage screening strategies could avoid 25% to 75% of laboratory testing used in CVD risk screening with predictive power comparable with Framingham risks.
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