Cost-effectiveness of applying high-sensitivity troponin I to a score for cardiovascular risk prediction in asymptomatic population

Paul Jülicher, Nataliya Makarova, Francisco Ojeda, Isabella Giusepi, Annette Peters, Barbara Thorand, Giancarlo Cesana, Torben Jørgensen, Allan Linneberg, Veikko Salomaa, Licia Iacoviello, Simona Costanzo, Stefan Söderberg, Frank Kee, Simona Giampaoli, Luigi Palmieri, Chiara Donfrancesco, Tanja Zeller, Kari Kuulasmaa, Tarja Tuovinen, Felicity Lamrock, Annette Conrads-Frank, Paolo Brambilla, Stefan Blankenberg and Uwe Siebert

PLOS ONE, 2024, vol. 19, issue 7, 1-24

Abstract: Introduction: Risk stratification scores such as the European Systematic COronary Risk Evaluation (SCORE) are used to guide individuals on cardiovascular disease (CVD) prevention. Adding high-sensitivity troponin I (hsTnI) to such risk scores has the potential to improve accuracy of CVD prediction. We investigated how applying hsTnI in addition to SCORE may impact management, outcome, and cost-effectiveness. Methods: Characteristics of 72,190 apparently healthy individuals from the Biomarker for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project were included into a discrete-event simulation comparing two strategies for assessing CVD risk. The standard strategy reflecting current practice employed SCORE (SCORE); the alternative strategy involved adding hsTnI information for further stratifying SCORE risk categories (S-SCORE). Individuals were followed over ten years from baseline examination to CVD event, death or end of follow-up. The model tracked the occurrence of events and calculated direct costs of screening, prevention, and treatment from a European health system perspective. Cost-effectiveness was expressed as incremental cost-effectiveness ratio (ICER) in € per quality-adjusted life year (QALYs) gained during 10 years of follow-up. Outputs were validated against observed rates, and results were tested in deterministic and probabilistic sensitivity analyses. Results: S-SCORE yielded a change in management for 10.0% of individuals, and a reduction in CVD events (4.85% vs. 5.38%, p

Date: 2024
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0307468

DOI: 10.1371/journal.pone.0307468

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