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dc.contributor.authorVenkataraman, P
dc.contributor.authorKawakami, H
dc.contributor.authorHuynh, Q
dc.contributor.authorMitchell, G
dc.contributor.authorNicholls, SJ
dc.contributor.authorStanton, T
dc.contributor.authorTonkin, A
dc.contributor.authorWatts, GF
dc.contributor.authorMarwick, TH
dc.date.accessioned2021-06-30T03:44:41Z
dc.date.available2021-06-30T03:44:41Z
dc.date.issued2021
dc.identifier.issn1936-878X
dc.identifier.doi10.1016/j.jcmg.2020.11.008
dc.identifier.urihttp://hdl.handle.net/10072/405488
dc.description.abstractObjectives: To assess the cost effectiveness of coronary artery calcium (CAC) compared with traditional risk factor–based prediction alone in those with an family history of premature coronary artery disease (FHCAD). Background: The use of CAC scoring to guide primary prevention statin therapy in those with a FHCAD is inconsistently recommended in guidelines, and usually not reimbursed by insurance. Methods: A microsimulation model was constructed in TreeAge Healthcare Pro using data from 1,083 participants in the CAUGHT-CAD (Coronary Artery Calcium Score: Use to Guide Management of HerediTary Coronary Artery Disease) trial. Outcomes assessed were quality-adjusted life years (QALYs): cost-effectiveness was assessed over a 15-year time horizon from the perspective of the US health care sector using real-world statin prescribing, accounting for the effect of knowledge of subclinical disease on adherence to guideline-directed therapies. Costs were assessed in 2020 USD, with discounting undertaken at 3%. Results: Statins were indicated in 45% of the cohort using the CAC strategy and 27% using American College of Cardiology/American Heart Association (2019) treatment strategies. Compared with applying a statin treatment threshold of 7.5%, the CAC strategy was more costly ($145) and more effective (0.0097 QALY) with an incremental cost-effective ratio (ICER) of $15,014/QALY. CAC ICER was driven by CAC acquisition and statin prescription cost and improved with certain patient subgroups: male, age >60 years, and 10-year risk pooled cohort equation risk ≥7.5%. CAC scanning of low-risk patients (10-year risk <5%) or those 40 to 50 years of age was not cost-effective. Conclusions: Systematic CAC screening and treatment of those with FHCAD and subclinical disease was more cost-effective than management using statin treatment thresholds, in the US health care system.
dc.description.peerreviewedYes
dc.languageeng
dc.publisherElsevier BV
dc.relation.ispartofpagefrom1206
dc.relation.ispartofpageto1217
dc.relation.ispartofissue6
dc.relation.ispartofjournalJACC: Cardiovascular Imaging
dc.relation.ispartofvolume14
dc.subject.fieldofresearchCardiorespiratory Medicine and Haematology
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchcode1102
dc.subject.fieldofresearchcode1103
dc.subject.keywordscoronary artery calcium score
dc.subject.keywordsprimary prevention
dc.subject.keywordsrisk prediction
dc.subject.keywordsstatins
dc.titleCost-Effectiveness of Coronary Artery Calcium Scoring in People With a Family History of Coronary Disease
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationVenkataraman, P; Kawakami, H; Huynh, Q; Mitchell, G; Nicholls, SJ; Stanton, T; Tonkin, A; Watts, GF; Marwick, TH, Cost-Effectiveness of Coronary Artery Calcium Scoring in People With a Family History of Coronary Disease, JACC: Cardiovascular Imaging, 2021, 14 (6), pp. 1206-1217
dcterms.dateAccepted2020-11-03
dc.date.updated2021-06-30T03:09:52Z
gro.hasfulltextNo Full Text
gro.griffith.authorStanton, Tony
gro.griffith.authorHuynh, Quan


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