Optimal cholesterol treatment plans and genetic testing strategies for cardiovascular diseases

Area of Science:

• Health Economics
• Genetics
• Cardiovascular Disease Research

Background:

• Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality in the US.
• The genetic underpinnings of ASCVD are recognized, but their impact on prevention and treatment strategies remains underexplored.
• Cholesterol is a key modifiable risk factor for ASCVD.

Purpose of the Study:

• To model patient health trajectories and optimize simultaneous treatment and genetic testing decisions for ASCVD.
• To quantify the impact of incorporating genetic information into ASCVD management.
• To determine the optimal timing and necessity of genetic testing for patients.

Main Methods:

• Stochastic modeling of patient health trajectories.
• Markov decision processes for cholesterol treatment plan optimization.
• Value of information analysis to guide genetic testing decisions.
• Simulation of health trajectories for over 64 million adult patients.

Main Results:

• An estimated 6.73 million patients would undergo genetic testing under the proposed model.
• Treatment plans incorporating both clinical and genetic information yielded 5,487 additional quality-adjusted life-years.
• These precision medicine-informed plans resulted in a cost saving of $1.18 billion compared to plans using only clinical data.

Conclusions:

• Integrating genetic testing into ASCVD management is clinically beneficial and cost-effective.
• Genetic information significantly enhances the optimization of treatment strategies for ASCVD.
• The findings underscore the growing importance of genetic insights in precision medicine for cardiovascular health.