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.
- Coronary heart disease
- Markov model
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine