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Cost-Effectiveness of Cardiovascular Screening in Patients With Rheumatoid Arthritis
Wietske Kievit1, Jake S F Maurits1, Elke E Arts1
1Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Insights
Cardiovascular disease screening in rheumatoid arthritis (RA) patients is cost-effective, offering a high probability of being less expensive and more effective. These findings support implementing routine CV risk screening for RA individuals.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Health Economics
Background:
- Patients with rheumatoid arthritis (RA) face an elevated risk of cardiovascular (CV) disease.
- Early detection and intervention are crucial for mitigating this excess CV risk in RA.
- The cost-effectiveness of implementing CV screening protocols in RA populations remains insufficiently understood.
Purpose of the Study:
- To evaluate the cost-effectiveness of cardiovascular screening in rheumatoid arthritis (RA) patients.
- To assess screening cost-effectiveness under various guideline-based scenarios.
- To determine the optimal approach for CV risk management in RA from a healthcare economic perspective.
Main Methods:
- A 10-year Markov chain model was employed for cost-effectiveness analysis.
- Model parameters were derived from existing literature and clinical data from RA patients.
- Quality-adjusted life year (QALY) gain and incremental cost-effectiveness ratio (ICER) were primary outcome measures.
Main Results:
- In the base case, CV screening was dominant (more effective and less costly) in 82% of simulations.
- Mean QALY gain was 0.09, with mean cost savings of €-1,057.
- Screening remained cost-effective across different scenarios, with a minimum dominance probability of 50% in conservative models.
Conclusions:
- Cardiovascular screening in RA patients is projected to be cost-effective.
- Screening demonstrates a high likelihood of being both less expensive and more effective than no screening.
- These results advocate for the adoption of CV risk screening protocols for individuals diagnosed with RA.
Objective:
Early detection and preemptive treatment of patients at risk is of great importance in reducing the excess risk of cardiovascular (CV) disease in rheumatoid arthritis (RA). However, it is unclear how much screening is cost-effective in RA. The objective is to assess whether CV screening in RA proves to be cost-effective from a medical perspective, using different scenarios based on different guidelines.
Methods:
A Markov chain model was used with a time horizon of 10 years. Parameter values were mainly obtained from literature and from RA patients screened for CV diseases at the Radboud University Medical Centre, Nijmegen, The Netherlands. The primary outcome was incremental cost-effectiveness expressed as costs per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analysis was performed and described in willingness-to-pay curves; several scenarios were built.
Results:
In the base case scenario, in 82% of the simulations, screening proved to be dominant compared to no screening. The mean QALY gain was 0.09 (95% percentile -0.07, 0.27), and the mean cost savings were €-1,057 (95% percentile -€2,825, €333). Different scenarios showed small differences in cost-effectiveness; the probability that screening is dominant remained high with the lowest probability being 50% for a very conservative scenario.
Conclusion:
Screening for CV events in RA patients was estimated to be cost-effective with high chances of being less expensive and more effective. These results support endorsement of screening for CV risk in patients with RA.
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