title: Is it cost-effective to use a test to decide which individuals with an intermediate cardiovascular disease risk would benefit from statin treatment?
abstract: BACKGROUND
  The 2012 European guidelines recommend statins for intermediate-risk individuals with elevated cholesterol levels. Improved discrimination of intermediate-risk individuals is needed to prevent both cardiovascular disease (CVD) and statin side-effects (e.g. myopathy) efficiently since only 3-15 in every 100 individuals actually experience a cardiovascular event in the next 10 years. We estimated the potential cost-effectiveness of a hypothetical test which helps to determine which individuals will benefit from statins.
  
  
  RESULTS
  Prognosis of different age- and gender-specific cohorts with an intermediate risk was simulated with a Markov model to estimate the potential costs and quality-adjusted life-years for four strategies: treat all with statins, treat none with statins, treat according to the European guidelines, or use a test to select individuals for statin treatment. The test-first strategy dominated the other strategies if the hypothetical test was 100% accurate and cost no more than €237. This strategy and the treat-all strategy were equally effective but the test generated lower costs by reducing statin usage and side-effects. The treat-none strategy was the least effective strategy. Threshold analyses show that the test must be highly accurate (especially sensitive) and inexpensive to be the most cost-effective strategy, since myopathy has a negligible impact on cost-effectiveness and statin costs are low.
  
  
  CONCLUSIONS
  Use of a highly accurate prognostic test could reduce overall CVD risk, frequency of drug side-effects and lifetime costs. However, no additional test would add usefully to risk prediction over SCORE when it does not satisfy the costs and accuracy requirements.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands. Electronic address: burgers@bmg.eur.nl.
authors.forename: L T
authors.initials: LT
authors.lastname: Burgers
authors.affiliation: Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: S T
authors.initials: ST
authors.lastname: Nauta
authors.affiliation: Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Deckers
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Severens
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
authors.forename: W K
authors.initials: WK
authors.lastname: Redekop
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: cardiovascular disease; cost-effectiveness; decision modelling; prevention; statins; test