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

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

Jülicher, Paul (författare): Medical Affairs, Core Diagnostics, Abbott, IL, Abbott Park, United States

Makarova, Nataliya (författare): Midwifery Science —Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany

Ojeda, Francisco (författare): Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany

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Giusepi, Isabella (författare): Medical Affairs, Core Diagnostics, Abbott, IL, Abbott Park, United States

Peters, Annette (författare): Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, München, Germany; Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany

Thorand, Barbara (författare): Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany

Cesana, Giancarlo (författare): Centro Studi Sanità Pubblica, Università Milano Bicocca, Milan, Italy

Jørgensen, Torben (författare): Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark

Linneberg, Allan (författare): Center for Clinical Research and Prevention, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Salomaa, Veikko (författare): Finnish Institute for Health and Welfare, Helsinki, Finland

Iacoviello, Licia (författare): Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Department of Medicine and Surgery, LUM University “Giuseppe Degennaro”, Casamassima, Italy

Costanzo, Simona (författare): Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy

Söderberg, Stefan (författare): Umeå universitet,Institutionen för folkhälsa och klinisk medicin

Kee, Frank (författare): Centre for Public Health, Queen’s University of Belfast, Belfast, United Kingdom

Giampaoli, Simona (författare): Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy

Palmieri, Luigi (författare): Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy

Donfrancesco, Chiara (författare): Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy

Zeller, Tanja (författare): German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany

Kuulasmaa, Kari (författare): Finnish Institute for Health and Welfare, Helsinki, Finland

Tuovinen, Tarja (författare): Finnish Institute for Health and Welfare, Helsinki, Finland

Lamrock, Felicity (författare): Mathematical Science Research Centre, Queen’s University Belfast, Northern Ireland, Belfast, United Kingdom

Conrads-Frank, Annette (författare): Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL, University for Health Sciences and Technology, Hall in Tirol, Austria

Brambilla, Paolo (författare): Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

Blankenberg, Stefan (författare): German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany

Siebert, Uwe (författare): Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL, University for Health Sciences and Technology, Hall in Tirol, Austria; Center for Health Decision Science, Depts. of Epidemiology and Health Policy & Management, Harvard Chan School of Public Health, MA, Boston, United States; Program on Cardiovascular Research, Institute for Technology Assessment, Dept. of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, Boston, United States

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Public Library of Science (PLoS), 2024
2024
Engelska.
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:7

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://umu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; visa färre...

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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<0.001) and mortality (6.80% vs. 7.04%, p<0.001). S-SCORE led to 23 (95%CI: 20–26) additional event-free years and 7 (95%CI: 5–9) additional QALYs per 1,000 subjects screened, and resulted in a relative risk reduction for CVD of 9.9% (95%CI: 7.3–13.5%) with a number needed to screen to prevent one event of 183 (95%CI: 172 to 203). S-SCORE increased costs per subject by 187€ (95%CI: 177 € to 196 €), leading to an ICER of 27,440€/QALY gained. Sensitivity analysis was performed with eligibility for treatment being the most sensitive.Conclusion: Adding a person’s hsTnI value to SCORE can impact clinical decision making and eventually improves QALYs and is cost-effective compared to CVD prevention strategies using SCORE alone. Stratifying SCORE risk classes for hsTnI would likely offer cost-effective alternatives, particularly when targeting higher risk groups.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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Av lärosätet: Umeå universitet

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

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