title: The economic impact of implementing a multiple inflammatory biomarker-based approach to identify, treat, and reduce cardiovascular risk.
abstract: OBJECTIVE
  To develop an economic model to estimate the change in the number of events and costs of non-fatal myocardial infarction (MI) and non-fatal ischemic stroke (IS) as a result of implementing routine risk-stratification with a multiple inflammatory biomarker approach.
  
  
  METHODS
  Reductions in the numbers of non-fatal MI and non-fatal IS events and in related per-member-per-month (PMPM) and 5-year costs (excluding test costs) due to biomarker testing were modeled for a US health plan with one million beneficiaries. Inputs for the model included literature-based MI and IS incidence rates, healthcare costs associated with MI and IS, laboratory results of biomarker testing, MI and IS hazard ratios related to biomarker levels, patient monitoring and intervention costs and use/costs of preventative pharmacotherapy. Preventative pharmacotherapy inputs were based on an analysis of pharmacy claims data. Costs savings (2013 USD) were assessed for patients undergoing biomarker testing compared to the standard of care. Data from MDVIP and Cleveland Heart Lab supported two critical inputs: (1) treatment success rates and (2) the population distribution of biomarker testing. Incidence rates, hazard ratios, and other healthcare costs were obtained from the literature.
  
  
  RESULTS
  For a health plan with one million members, an estimated 21,104 MI and 22,589 IS events occurred in a 5-year period. Routine biomarker testing among a sub-group of beneficiaries ≥35 years old reduced non-fatal MI and IS events by 2039 and 1869, respectively, yielding cost savings of over $187 million over 5 years ($3.13 PMPM), excluding test costs. Results were sensitive to changes in treatment response rates. Nonetheless, cost savings were observed for all input values.
  
  
  CONCLUSIONS
  This study suggests that health plans can realize substantial cost savings by preventing non-fatal MI and IS events after implementation of routine biomarker testing. Five-year cost savings before test costs could exceed $3.13 PMPM.
authors.affiliation: Cleveland HeartLab, Inc., Cleveland, OH, USA, and Summa Cardiovascular Institute, Summa Health System , Akron, OH , USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Penn
authors.forename: M A
authors.initials: MA
authors.lastname: Yenikomshian
authors.forename: A K G
authors.initials: AK
authors.lastname: Cummings
authors.forename: A
authors.initials: A
authors.lastname: Klemes
authors.forename: J M
authors.initials: JM
authors.lastname: Damron
authors.forename: S
authors.initials: S
authors.lastname: Purvis
authors.forename: M
authors.initials: M
authors.lastname: Beidelschies
authors.forename: H G
authors.initials: HG
authors.lastname: Birnbaum
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000191:economics*; D002318:Cardiovascular Diseases / Q000097:blood / Q000191:economics* / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D005260:Female; D006403:Hematologic Tests / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D009195:Peroxidase / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D014481:United States
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D002097:C-Reactive Protein; D009195:Peroxidase; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase
keywords: Budget-impact analysis; Cardiovascular risk; Inflammation biomarker; Myeloperoxidase