title: Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men.
abstract: BACKGROUND
  HIV-infected patients are at increased risk of coronary artery disease (CAD). We evaluated the cost-effectiveness of cardiac screening for HIV-positive men at intermediate or greater CAD risk.
  
  
  METHODS
  We developed a lifetime microsimulation model of CAD incidence and progression in HIV-infected men.
  
  
  METHODS
  Input parameters were derived from two HIV cohort studies and the literature. We compared no CAD screening with stress testing and coronary computed tomography angiography (CCTA)-based strategies. Patients with test results indicating 3-vessel/left main CAD underwent invasive coronary angiography (ICA) and received coronary artery bypass graft surgery. In the stress testing + medication and CCTA + medication strategies, patients with 1-2-vessel CAD results received lifetime medical treatment without further diagnostics whereas in the stress testing + intervention and CCTA + intervention strategies, patients with these results underwent ICA and received percutaneous coronary intervention.
  
  
  RESULTS
  Compared to no screening, the stress testing + medication, stress testing + intervention, CCTA + medication, and CCTA + intervention strategies resulted in 14, 11, 19, and 14 quality-adjusted life days per patient and incremental cost-effectiveness ratios of 49,261, 57,817, 34,887 and 56,518 Euros per quality-adjusted life year (QALY), respectively. Screening only at higher CAD risk thresholds was more cost-effective. Repeated screening was clinically beneficial compared to one-time screening, but only stress testing + medication every 5 years remained cost-effective. At a willingness-to-pay threshold of 83,000 €/QALY (∼ 100,000 US$/QALY), implementing any CAD screening was cost-effective with a probability of 75-95%.
  
  
  CONCLUSIONS
  Screening HIV-positive men for CAD would be clinically beneficial and comes at a cost-effectiveness ratio comparable to other accepted interventions in HIV care.
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
authors.forename: Julia E H
authors.initials: JE
authors.lastname: Nolte
authors.affiliation: West German Heart Institute, University of Duisburg-Essen, Essen, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Manne
authors.affiliation: Program in Nutritional Metabolism, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Lo
authors.affiliation: Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Neumann
authors.affiliation: Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mostardt
authors.affiliation: Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.affiliation: Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.affiliation: Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Wasem
authors.affiliation: Program in Nutritional Metabolism, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Grinspoon
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, USA.
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Deptartment of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria alex@mgh-ita.org.
authors.forename: Alexander
authors.initials: A
authors.lastname: Goehler
mesh_terms: D000328:Adult; D017023:Coronary Angiography / Q000191:economics*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D025401:Echocardiography, Stress / Q000191:economics*; D004562:Electrocardiography / Q000191:economics*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*
keywords: Coronary heart disease; HIV; Markov model; cost-effectiveness; prevention
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