title: Echocardiographic quantification of atherosclerosis leads to cost-effective treatment with statins.
abstract: 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.
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Balthasar
authors.initials: B
authors.lastname: Hug
authors.forename: Christian
authors.initials: C
authors.lastname: Jansen
authors.forename: Vânia
authors.initials: V
authors.lastname: Barbosa
authors.forename: Dagmar
authors.initials: D
authors.lastname: Keller
authors.forename: Peter T
authors.initials: PT
authors.lastname: Buser
authors.forename: Martin
authors.initials: M
authors.lastname: Siegemund
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Hunziker
mesh_terms: 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
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors