Implications of Coronary Artery Calcium Testing for Treatment Decisions Among Statin Candidates According to the ACC/AHA Cholesterol Management Guidelines: A Cost-Effectiveness Analysis

JACC: Cardiovascular Imaging

Volumn 10, Issue 8, 2017, Pages 938-952

  Hong, Jonathan C ^a,b   Blankstein, Ron ^c   Shaw, Leslee J ^d   Padula, William V ^a,b   Arrieta, Alejandro ^e   Fialkow, Jonathan A ^f   Blumenthal, Roger S ^g   Blaha, Michael J ^g   Krumholz, Harlan M ^h   Nasir, Khurram ^f,g,i  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^b JOHNS HOPKINS UNIVERSITY SCHOOL OF NURSING   (United States)

^c BRIGHAM AND WOMEN S HOSPITAL   (United States)

^d EMORY UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e FLORIDA INTERNATIONAL UNIVERSITY   (United States)

^f BAPTIST CARDIAC AND VASCULAR INSTITUTE   (United States)

^g JOHNS HOPKINS UNIVERSITY   (United States)

^h YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

ⁱ MIAMI CANCER INSTITUTE   (United States)

Author keywords

atherosclerosis; CAC; cholesterol; cost effectiveness analysis; risk assessment; statins

Indexed keywords

CHOLESTEROL; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR;

CARDIOVASCULAR DISEASE; CLINICAL EFFECTIVENESS; CORONARY ARTERY ATHEROSCLEROSIS; CORONARY ARTERY CALCIUM SCORE; COST EFFECTIVENESS ANALYSIS; ECONOMIC ASPECT; HUMAN; MEDICAL DECISION MAKING; MEDICATION COMPLIANCE; PATIENT COMPLIANCE; PRACTICE GUIDELINE; PRIORITY JOURNAL; QUALITY ADJUSTED LIFE YEAR; REVIEW; SHARED DECISION MAKING; STRATEGIC PLANNING; TREATMENT OUTCOME; TREATMENT PLANNING; AGED; BAYES THEOREM; BLOOD VESSEL CALCIFICATION; CLINICAL DECISION MAKING; COMPUTER SIMULATION; CORONARY ANGIOGRAPHY; CORONARY ARTERY DISEASE; CORONARY BLOOD VESSEL; COST BENEFIT ANALYSIS; DECISION SUPPORT SYSTEM; DIAGNOSTIC IMAGING; DRUG COST; DRUG EFFECTS; ECONOMIC MODEL; ECONOMICS; FEMALE; MALE; MEDICAL SOCIETY; MIDDLE AGED; MONTE CARLO METHOD; MULTIVARIATE ANALYSIS; PREDICTIVE VALUE; PROTOCOL COMPLIANCE; QUALITY OF LIFE; TIME FACTOR; UNITED STATES; VERY ELDERLY;

AGED; AGED, 80 AND OVER; AMERICAN HEART ASSOCIATION; BAYES THEOREM; CLINICAL DECISION-MAKING; COMPUTER SIMULATION; CORONARY ANGIOGRAPHY; CORONARY ARTERY DISEASE; CORONARY VESSELS; COST-BENEFIT ANALYSIS; DECISION SUPPORT TECHNIQUES; DRUG COSTS; FEMALE; GUIDELINE ADHERENCE; HUMANS; HYDROXYMETHYLGLUTARYL-COA REDUCTASE INHIBITORS; MALE; MIDDLE AGED; MODELS, ECONOMIC; MONTE CARLO METHOD; MULTIVARIATE ANALYSIS; PRACTICE GUIDELINES AS TOPIC; PREDICTIVE VALUE OF TESTS; QUALITY OF LIFE; QUALITY-ADJUSTED LIFE YEARS; TIME FACTORS; TREATMENT OUTCOME; UNITED STATES; VASCULAR CALCIFICATION;

EID: 85026852638     PISSN: 1936878X     EISSN: 18767591     Source Type: Journal    
DOI: 10.1016/j.jcmg.2017.04.014     Document Type: Review

References (59)

1. Stone, N.J., Robinson, J.G., Lichtenstein, A.H., et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63 (2014), 2889–2934.
2. Goff, D.C. Jr., Lloyd-Jones, D.M., Bennett, G., et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63 (2014), 2935–2959.
3. Pencina, M.J., Navar-Boggan, A.M., D'Agostino, R.B. Sr., et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med 370 (2014), 1422–1431.
4. Ridker, P.M., Cook, N.R., Statins: new American guidelines for prevention of cardiovascular disease. Lancet 382 (2013), 1762–1765.
5. DeFilippis, A.P., Young, R., Carrubba, C.J., et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med 162 (2015), 266–275.
6. Martin, S.S., Sperling, L.S., Blaha, M.J., et al. Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA guidelines. J Am Coll Cardiol 65 (2015), 1361–1368.
7. Sarwar, A., Shaw, L.J., Shapiro, M.D., et al. Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img 2 (2009), 675–688.
8. Polonsky, T.S., McClelland, R.L., Jorgensen, N.W., et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 303 (2010), 1610–1616.
9. Blaha, M.J., Cainzos-Achirica, M., Greenland, P., et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 133 (2016), 849–858.
10. Nasir, K., Bittencourt, M.S., Blaha, M.J., et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association Cholesterol Management guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 66 (2015), 1657–1668.
11. Mahabadi, A.A., Mohlenkamp, S., Lehmann, N., et al. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. J Am Coll Cardiol Img 10 (2017), 143–153.
12. Pursnani, A., Massaro, J.M., D'Agostino, R.B. Sr., O'Donnell, C.J., Hoffmann, U., Guideline-based statin eligibility, coronary artery calcification, and cardiovascular events. JAMA 314 (2015), 134–141.
13. Hlatky, M.A., Greenland, P., Arnett, D.K., et al. Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association. Circulation 119 (2009), 2408–2416.
14. van Kempen, B.J., Spronk, S., Koller, M.T., et al. Comparative effectiveness and cost-effectiveness of computed tomography screening for coronary artery calcium in asymptomatic individuals. J Am Coll Cardiol 58 (2011), 1690–1701.
15. Pletcher, M.J., Pignone, M., Earnshaw, S., et al. Using the coronary artery calcium score to guide statin therapy: a cost-effectiveness analysis. Circ Cardiovasc Qual Outcomes 7 (2014), 276–284.
16. Roberts, E.T., Horne, A., Martin, S.S., et al. Cost-effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One, 10, 2015, e0116377.
17. Galper, B.Z., Wang, Y.C., Einstein, A.J., Strategies for primary prevention of coronary heart disease based on risk stratification by the ACC/AHA lipid guidelines, ATP III guidelines, coronary calcium scoring, and C-reactive protein, and a global treat-all strategy: a comparative-effectiveness modeling study. PLoS One, 10, 2015, e0138092.
18. van Kempen, B.J., Ferket, B.S., Steyerberg, E.W., Max, W., Myriam Hunink, M.G., Fleischmann, K.E., Comparing the cost-effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population. Int J Cardiol 203 (2016), 422–431.
19. Bild, D.E., Bluemke, D.A., Burke, G.L., et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol 156 (2002), 871–881.
20. Tonelli, M., Lloyd, A., Clement, F., et al. Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis. CMAJ 183 (2011), E1189–E1202.
21. Brugts, J.J., Yetgin, T., Hoeks, S.E., et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ, 338, 2009, b2376.
22. Shah, P.K., Screening asymptomatic subjects for subclinical atherosclerosis: can we, does it matter, and should we?. J Am Coll Cardiol 56 (2010), 98–105.
23. Kalia, N.K., Miller, L.G., Nasir, K., Blumenthal, R.S., Agrawal, N., Budoff, M.J., Visualizing coronary calcium is associated with improvements in adherence to statin therapy. Atherosclerosis 185 (2006), 394–399.
24. Taylor, A.J., Bindeman, J., Feuerstein, I., et al. Community-based provision of statin and aspirin after the detection of coronary artery calcium within a community-based screening cohort. J Am Coll Cardiol 51 (2008), 1337–1341.
25. Lee, K.K., Cipriano, L.E., Owens, D.K., Go, A.S., Hlatky, M.A., Cost-effectiveness of using high-sensitivity C-reactive protein to identify intermediate- and low-cardiovascular-risk individuals for statin therapy. Circulation 122 (2010), 1478–1487.
26. Arias, E., United States life tables, 2010. Natl Vital Stat Rep 63 (2014), 1–63.
27. O'Sullivan, A.K., Rubin, J., Nyambose, J., Kuznik, A., Cohen, D.J., Thompson, D., Cost estimation of cardiovascular disease events in the US. Pharmacoeconomics 29 (2011), 693–704.
28. Grover, S.A., Ho, V., Lavoie, F., Coupal, L., Zowall, H., Pilote, L., The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins?. Arch Intern Med 163 (2003), 333–339.
29. Centers for Medicare & Medicaid Services. Physician Fee Schedule: Overview. 2017. Available at: https://www.cms.gov/apps/physician-fee-schedule Accessed March 23, 2017.
30. Machaalany, J., Yam, Y., Ruddy, T.D., et al. Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography. J Am Coll Cardiol 54 (2009), 1533–1541.
31. Schragin, J.G., Weissfeld, J.L., Edmundowicz, D., Strollo, D.C., Fuhrman, C.R., Non-cardiac findings on coronary electron beam computed tomography scanning. J Thorac Imaging 19 (2004), 82–86.
32. Bureau of Labor Statistics. National Occupational Employment and Wage Estimates. Available at: https://www.bls.gov/oes/current/oes_nat.htm Accessed March 23, 2017.
33. Truven Health Analytics. Red Book Online. 2016, Truven Health Analytics, Greenwood Village, CO.
34. Salami, J.A., Warraich, H., Valero-Elizondo, J., et al. National trends in statin use and expenditures in the US adult population from 2002 to 2013: insights from the Medical Expenditure Panel Survey. JAMA Cardiol 2 (2017), 56–65.
35. Gerber, T.C., Carr, J.J., Arai, A.E., et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation 119 (2009), 1056–1065.
36. Nasir, K., Overhauling cardiovascular risk prediction in primary prevention: difficult journey worth the destination. Circ Cardiovasc Qual Outcomes 8 (2015), 466–468.
37. Hutchins, R., Viera, A.J., Sheridan, S.L., Pignone, M.P., Quantifying the utility of taking pills for cardiovascular prevention. Circ Cardiovasc Qual Outcomes 8 (2015), 155–163.
38. Elias-Smale, S.E., Proenca, R.V., Koller, M.T., et al. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol 56 (2010), 1407–1414.
39. Thompson, A., Guthrie, B., Payne, K., Do pills have no ills? Capturing the impact of direct treatment disutility. Pharmacoeconomics 34 (2016), 333–336.
40. Fontana, M., Asaria, P., Moraldo, M., et al. Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility. Circulation 129 (2014), 2539–2546.
41. Hutchins, R., Pignone, M.P., Sheridan, S.L., Viera, A.J., Quantifying the utility of taking pills for preventing adverse health outcomes: a cross-sectional survey. BMJ Open, 5, 2015, e006505.
42. Neumann, P.J., Sanders, G.D., Russell, L.B., Siegel, J.E., Ganiats, T.G., (eds.) Cost-Effectiveness in Health and Medicine, 2nd edition, 2016, Oxford University Press, New York, NY.
43. Drummond, M.F., Sculpher, M.J., Torrance, G.W., O'Brien, B.J., Stoddart, G.L., Methods for the Economic Evaluation of Health Care Programmes. 3rd edition, 2005, Oxford University Press, New York, NY.
44. Garber, A.M., Phelps, C.E., Economic foundations of cost-effectiveness analysis. J Health Econ 16 (1997), 1–31.
45. van Baal, P., Meltzer, D., Brouwer, W., Future costs, fixed healthcare budgets, and the decision rules of cost-effectiveness analysis. Health Econ 25 (2016), 237–248.
46. National Institute for Health and Care Excellence. Guide to the Methods of Technology Appraisal 2013. April 2013. Available at: https://www.nice.org.uk/process/pmg9/chapter/foreword Accessed April 12, 2017.
47. Sabatine, M.S., Giugliano, R.P., Keech, A.C., et al., FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 376 (2017), 1713–1722.
48. Arrieta, A., Page, T.F., Veledar, E., Nasir, K., Economic evaluation of PCSK9 inhibitors in reducing cardiovascular risk from health system and private payer perspectives. PLoS One, 12, 2017, e0169761.
49. Petty, G.W., Brown, R.D. Jr., Whisnant, J.P., Sicks, J.D., O'Fallon, W.M., Wiebers, D.O., Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975 through 1989. Neurology 50 (1998), 208–216.
50. Roger, V.L., Weston, S.A., Gerber, Y., et al. Trends in incidence, severity, and outcome of hospitalized myocardial infarction. Circulation 121 (2010), 863–869.
51. Velagaleti, R.S., Pencina, M.J., Murabito, J.M., et al. Long-term trends in the incidence of heart failure after myocardial infarction. Circulation 118 (2008), 2057–2062.
52. Kasliwal, R., Wilton, L.V., Cornelius, V., Aurich-Barrera, B., Shakir, S.A., Safety profile of rosuvastatin: results of a prescription-event monitoring study of 11,680 patients. Drug Saf 30 (2007), 157–170.
53. Alsheikh-Ali, A.A., Ambrose, M.S., Kuvin, J.T., Karas, R.H., The safety of rosuvastatin as used in common clinical practice: a postmarketing analysis. Circulation 111 (2005), 3051–3057.
54. Kim, K.P., Einstein, A.J., Berrington de Gonzalez, A., Coronary artery calcification screening: estimated radiation dose and cancer risk. Arch Intern Med 169 (2009), 1188–1194.
55. Einstein, A.J., Henzlova, M.J., Rajagopalan, S., Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298 (2007), 317–323.
56. Bureau of Labor Statistics. Table 1300. Age of Reference Person: Annual Expenditure Means, Shares, Standard Errors, and Coefficient of Variation, Consumer Expenditure Survey, 2013. September 2014. Available at: https://www.bls.gov/cex/2013/combined/age.pdf. Accessed April 10, 2017.
57. Centers for Medicare & Medicaid Services. Clinical Laboratory Fee Schedule. Available at: https://www.cms.gov/apps/ama/license.asp?file=/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads/17CLAB.zip Accessed March 23, 2017.
58. Sullivan, P.W., Ghushchyan, V., Preference-based EQ-5D index scores for chronic conditions in the United States. Med Decis Making 26 (2006), 410–420.
59. Sullivan, P.W., Ghushchyan, V., Mapping the EQ-5D index from the SF-12: US general population preferences in a nationally representative sample. Med Decis Making 26 (2006), 401–409.