Poon A, Savage K, Goodman C; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1998; 14: 83.
The Lewin Group, Fairfax, VA, USA.
BACKGROUND/OBJECTIVE: Ultrafast computer tomography (ultrafast CT) is emerging as a noninvasive technology for detecting coronary artery disease (CAD) in asymptomatic populations based on measured coronary artery calcification (CAC). This technology could compete or be used in conjuction with the current guidelines for detection based on risk factors (e.g., cholesterol, hypertension, smoking) identified by the National Cholesterol Education Program II (NCEP II, US). Ultrafast CT is offered as a means for enabling appropriate management of at-risk patients not identified by NCEP II and as a means for avoiding unnecessary treatment in patients with high cholesterol but at low risk for CAD. There is currently only limited long-term outcomes data available on the predictive value of ultrafast CT. Therefore, we used decision analytic modeling to analyze the outcomes and costs of screening with NCEP II guidelines alone as compared with screening with NCEP II guidelines and ultrafast CT guidelines. METHODS: The Framingham Risk Equation for CAD was applied to the National Health and Nutrition Examination Survey III (NHANES III, US) to determine the risk of CAD for each of 5 risk-groups derived from NCEP II guidelines. Risk for each NCEP II group was refined using CAC risk-ratios calculated from a model linking CAC to CAD event rates. The model links CAC to extent of stenosis using data supplied by ultrafast CT clinics, and then links the extent of stenosis to a risk of CAD using angiographic literature. Interventions were selected according to either the NCEP II guidelines alone or the NCEP II guidelines and ultrafast CT guidelines. Each intervention was assumed to change the risk-factors to each person in NHANES III. The Framingham Equation was then re-applied to the modified NHANES III population. Cost of therapy and events was approximated using evidence from the literature and costed using Medicare fees and average wholesale prices (AWPs, US) of statin drugs. RESULTS AND CONCLUSIONS: Ultrafast CT provides information that allows a greater stratification (than NCEP II alone) of the risk of CAD for asymptomatic patients. Preliminary analyses suggest that ultrafast CT appears to be cost-effective in identifying patients with high cholesterol who are at low risk of CAD. Ultrafast CT may also be cost-effective in identifying patients with low cholesterol who are at high risk of CAD. Sensitivity analyses reveal that all results are highly sensitive to three parameters: 1) the interventions selected, 2) assumptions made about the cost of an compliance with statin therapy, and 3) the low prevalence of disease and calcification in an asymptomatic population.
Publication Types:
Keywords:
- Cholesterol
- Constriction, Pathologic
- Coronary Artery Disease
- Coronary Vessels
- Guidelines as Topic
- Humans
- Hyperlipidemias
- Mass Screening
- Population
- Population Groups
- Practice Guidelines as Topic
- Risk Factors
- Sensitivity and Specificity
- Tomography, X-Ray Computed
- radiography
- hsrmtgs
Other ID:
UI: 102237045
From Meeting Abstracts