title: Prognostic value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein as a marker for major cardiac events in asymptomatic individuals: a health technology assessment report.
abstract: OBJECTIVE
  The aim of this study was to compare the predictive value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein (hs-CRP)-screening in addition to traditional risk factor screening in apparently healthy persons as a means of preventing coronary artery disease.
  
  
  RESULTS
  The systematic review was performed according to internationally recognized methods. Seven studies on risk prediction, one clinical decision-analytic modeling study, and three decision-analytic cost-effectiveness studies were included. The adjusted relative risk of high hs-CRP-level ranged from 0.7 to 2.47 (p < .05 in four of seven studies). Adding hs-CRP to the prediction models increased the areas under the curve by 0.00 to 0.027. Based on the clinical decision analysis, both individuals with elevated hs-CRP-levels and those with hyperlipidemia have a similar gain in life expectancy following statin therapy. One high-quality economic modeling study suggests favorable incremental cost-effectiveness ratios for persons with elevated hs-CRP and higher risk. However, many model parameters were based on limited evidence.
  
  
  CONCLUSIONS
  Adding hs-CRP to traditional risk factors improves risk prediction, but the clinical relevance and cost-effectiveness of this improvement remain unclear.
authors.affiliation: Institute for Health Care Management, University for Health Sciences, Medical Informatics and Technology and University of Duisburg-Essen, Essen, Germany. petra.schnell-inderst@umit.at
authors.forename: Petra
authors.initials: P
authors.lastname: Schnell-Inderst
authors.forename: Ruth
authors.initials: R
authors.lastname: Schwarzer
authors.forename: Alexander
authors.initials: A
authors.lastname: Göhler
authors.forename: Norma
authors.initials: N
authors.lastname: Grandi
authors.forename: Kristin
authors.initials: K
authors.lastname: Grabein
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
authors.forename: Jennifer
authors.initials: J
authors.lastname: Manne
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
mesh_terms: D000367:Age Factors; D002097:C-Reactive Protein / Q000032:analysis*; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein