title: Cost-Effectiveness of Cardiovascular Screening in Patients With Rheumatoid Arthritis.
abstract: OBJECTIVE
  Early detection and preemptive treatment of patients at risk is of great importance in reducing the excess risk of cardiovascular (CV) disease in rheumatoid arthritis (RA). However, it is unclear how much screening is cost-effective in RA. The objective is to assess whether CV screening in RA proves to be cost-effective from a medical perspective, using different scenarios based on different guidelines.
  
  
  METHODS
  A Markov chain model was used with a time horizon of 10 years. Parameter values were mainly obtained from literature and from RA patients screened for CV diseases at the Radboud University Medical Centre, Nijmegen, The Netherlands. The primary outcome was incremental cost-effectiveness expressed as costs per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analysis was performed and described in willingness-to-pay curves; several scenarios were built.
  
  
  RESULTS
  In the base case scenario, in 82% of the simulations, screening proved to be dominant compared to no screening. The mean QALY gain was 0.09 (95% percentile -0.07, 0.27), and the mean cost savings were €-1,057 (95% percentile -€2,825, €333). Different scenarios showed small differences in cost-effectiveness; the probability that screening is dominant remained high with the lowest probability being 50% for a very conservative scenario.
  
  
  CONCLUSIONS
  Screening for CV events in RA patients was estimated to be cost-effective with high chances of being less expensive and more effective. These results support endorsement of screening for CV risk in patients with RA.
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Wietske
authors.initials: W
authors.lastname: Kievit
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jake S F
authors.initials: JS
authors.lastname: Maurits
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Elke E
authors.initials: EE
authors.lastname: Arts
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, and Bernhoven Hospital, Uden, The Netherlands.
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Fransen
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, and Bernhoven Hospital, Uden, The Netherlands.
authors.forename: Calin D
authors.initials: CD
authors.lastname: Popa
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000191:economics; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D018803:Models, Economic; D009426:Netherlands; D019057:Quality-Adjusted Life Years