Echocardiographic quantification of atherosclerosis leads to cost-effective treatment with statins.
OBJECTIVE
Use of statins in prevention of atherosclerosis is effective but expensive. Patient selection gains wider public attention as medication costs in the US and Europe augment by 8% to 10% per year. We examined different clinical risk stratification strategies, particularly focusing on echocardiographic atherosclerosis quantification, for their impact on event reduction and cost-effectiveness in statin treatment.


RESULTS
In a prospective, consecutive cohort of 336 patients referred to non-invasive cardiac examination, risk stratification was done by various combinations of risk factors and noninvasive atherosclerosis quantification. Atherosclerotic burden was determined through measuring "aortic elastance" by transthoracic echocardiogram, a validated non-invasive method. Cardiovascular events were recorded at a mean follow-up of one year. Echocardiographically determined atherosclerosis severity and event history, especially in combination, yielded the best selection strategies for statin treatment over a broad range of predetermined funding or required event reductions, surpassing conventional cardiovascular risk factors. From 26.8 statin-preventable events/1000 patients/year (assuming all patients treated), the best selection strategies could avoid: 24 with 66% of the cost for statin treatment (atherosclerosis and age criteria), 20.1 with <50% of the budget, 12.2 with <30% of the budget or 9.6 with <15% of the budget (using combinations of atherosclerosis and prior events), while conventional strategies without echo quantification of atherosclerosis were inferior.


CONCLUSIONS
Non-invasive echocardiographic quantification of atherosclerosis improves efficiency and cost-effectiveness in statin treatment.
Nietlispach
Fabian
F
Division of Cardiology, University Hospital Basel, Switzerland.
Hug
Balthasar
B
Jansen
Christian
C
Barbosa
Vânia
V
Keller
Dagmar
D
Buser
Peter T
PT
Siegemund
Martin
M
Marsch
Stephan
S
Hunziker
Patrick R
PR
D000368:Aged; D001161:Arteriosclerosis / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004452:Echocardiography; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors