Abstract 10633: Coronary Artery Calcium Screening Cost-Effective in Men, Not in Women
Introduction Coronary artery calcium on CT significantly improves the prediction of coronary heart disease (CHD) beyond traditional risk factors. We hypothesized that coronary artery calcium screening would be effective against acceptable costs in both men and women. We assessed its effectiveness and cost-effectiveness in asymptomatic individuals at intermediate risk of CHD.
Methods We developed a computer-simulation state-transition model using data from the Rotterdam Study, a population based cohort study (n=2028). We compared coronary calcium screening with: (1) current practice as observed in the Rotterdam Study, (2) full implementation of current CVD prevention guidelines and (3) statin therapy for all individuals. Asymptomatic study participants at intermediate risk of CHD were simulated over their remaining lifetime. Quality-adjusted life expectancy in years (QALYs), costs and incremental cost-effectiveness ratios were calculated.
Results In men, coronary calcium screening increases quality adjusted life expectancy against additional costs compared to the other 3 strategies (coronary calcium screening vs current practice: +0.13 QALY [95%CI 0.01;0.26], +$4,676 [95%CI 3,126 ; 6,339], coronary calcium screening vs current guidelines: +0.02 QALY [-0.04;0.09], +$44 [-441 ; 486 and coronary calcium screening vs statin therapy: +0.04 QALY [-0.02;0.13], +$1,951 [1170 ; 2754]). Implementing coronary calcium screening in men would cost society $48,800 per year gained in full health. In women, coronary calcium screening is more effective and more costly than current practice (+0.13 QALY [0.02;0.28], +$4,663 [3,120 ; 6,277]) and statin therapy (+0.03 QALY [-0.03;0.12], +$2,273 [1475 ;3109]). However, fully implementing current CVD prevention guidelines is more effective compared to coronary calcium screening (+0.02 QALY [-0.03;0.07]), only a little more expensive (+$297 [-8 ;633]), and has a lower cost per increase in quality adjusted life expectancy ($33,072/QALY vs $ 35,869/QALY).
Conclusions Screening for coronary artery calcium with CT in asymptomatic individuals at intermediate risk of CHD is cost-effective in men, but not in women.
- © 2011 by American Heart Association, Inc.