TY - JOUR
T1 - Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men
AU - Nolte, Julia Eh
AU - Neumann, Till
AU - Manne, Jennifer M.
AU - Lo, Janet
AU - Neumann, Anja
AU - Mostardt, Sarah
AU - Abbara, Suhny
AU - Hoffmann, Udo
AU - Brady, Thomas J.
AU - Wasem, Juergen
AU - Grinspoon, Steven K.
AU - Gazelle, G. Scott
AU - Goehler, Alexander
N1 - Funding Information:
This work was supported by the German Competence Network Heart Failure (stipend to JEHN) and the National Institute of Health (Ruth Kirschstein National Research Award T32 to AG, NIH R01 HL095123 and K24 DK 064545 to SKG, K23 HL 092792 to JL).
PY - 2014/8
Y1 - 2014/8
N2 - 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.
AB - 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.
KW - Coronary heart disease
KW - HIV
KW - Markov model
KW - cost-effectiveness
KW - prevention
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U2 - 10.1177/2047487313483607
DO - 10.1177/2047487313483607
M3 - Article
C2 - 23539717
AN - SCOPUS:84904888149
SN - 2047-4873
VL - 21
SP - 972
EP - 979
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 8
ER -