Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men

Julia Eh Nolte, Till Neumann, Jennifer M. Manne, Janet Lo, Anja Neumann, Sarah Mostardt, Suhny Abbara, Udo Hoffmann, Thomas J. Brady, Juergen Wasem, Steven K. Grinspoon, G. Scott Gazelle, Alexander Goehler

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Background: HIV-infected patients are at increased risk of coronary artery disease (CAD). We evaluated the costeffectiveness of cardiac screening for HIV-positive men at intermediate or greater CAD risk. Design: We developed a lifetime microsimulation model of CAD incidence and progression in HIV-infected men. Methods: Input parameters were derived from two HIV cohort studies and the literature. We compared no CAD screening with stress testing and coronary computed tomography angiography (CCTA)-based strategies. Patients with test results indicating 3-vessel/left main CAD underwent invasive coronary angiography (ICA) and received coronary artery bypass graft surgery. In the stress testing+medication and CCTA+medication strategies, patients with 1-2-vessel CAD results received lifetime medical treatment without further diagnostics whereas in the stress testing+intervention and CCTA+intervention strategies, patients with these results underwent ICA and received percutaneous coronary intervention. Results: Compared to no screening, the stress testing+medication, stress testing+intervention, CCTA+medication, and CCTA+intervention strategies resulted in 14, 11, 19, and 14 quality-adjusted life days per patient and incremental cost-effectiveness ratios of 49,261, 57,817, 34,887 and 56,518 Euros per quality-adjusted life year (QALY), respectively. Screening only at higher CAD risk thresholds was more cost-effective. Repeated screening was clinically beneficial compared to one-time screening, but only stress testing+medication every 5 years remained cost-effective. At a willingness-to-pay threshold of 83,000 €/QALY (7sim;100,000 US/QALY), implementing any CAD screening was costeffective with a probability of 75-95%.Conclusions: Screening HIV-positive men for CAD would be clinically beneficial and comes at a cost-effectiveness ratio comparable to other accepted interventions in HIV care.

Original languageEnglish (US)
Pages (from-to)972-979
Number of pages8
JournalEuropean Journal of Preventive Cardiology
Volume21
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Coronary heart disease
  • HIV
  • Markov model
  • cost-effectiveness
  • prevention

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Nolte, J. E., Neumann, T., Manne, J. M., Lo, J., Neumann, A., Mostardt, S., Abbara, S., Hoffmann, U., Brady, T. J., Wasem, J., Grinspoon, S. K., Gazelle, G. S., & Goehler, A. (2014). Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men. European Journal of Preventive Cardiology, 21(8), 972-979. https://doi.org/10.1177/2047487313483607