Evidence map›Paper›PMID 36841547›Full record

ArticleThe Medical journal of Australia2023

The cost-effectiveness of coronary calcium score-guided statin therapy initiation for Australians with family histories of premature coronary artery disease.

Prasanna Venkataraman, Amanda L Neil, Geoffrey K Mitchell, Tony Stanton, Stephen Nicholls, Andrew M Tonkin, Gerald F Watts, Thomas H Marwick

Open access · bronzeAbstract readComparative Study
PubMed Publisher
In one paragraph

Article in The Medical journal of Australia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
1.8field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Observational
  6. Article
  7. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 1 country.

Prasanna VenkataramanBaker Heart and Diabetes Institute, Melbourne, VIC.
Amanda L NeilMenzies Research Institute Tasmania, University of Tasmania, Hobart, TAS.ORCID 0000-0002-1344-6672
Geoffrey K MitchellThe University of Queensland, Brisbane, QLD.ORCID 0000-0001-7817-6821
Tony StantonThe University of Queensland, Brisbane, QLD.
Stephen NichollsMonash Medical Centre, Monash University, Melbourne, VIC.
Andrew M TonkinMonash University, Melbourne, VIC.ORCID 0000-0001-5291-0610
Gerald F WattsThe University of Western Australia, Perth, WA.
Thomas H MarwickBaker Heart and Diabetes Institute, Melbourne, VIC.ORCID 0000-0001-9065-0899
Baker Heart and Diabetes Institute · AUThe University of Queensland · AUMonash Medical Centre · AUMonash University · AUThe University of Western Australia · AUUniversity of Tasmania · AU

Funding

National Health and Medical Research Council Project grant 1080582
6 · The paper itself

Abstract

objectivesTo compare the cost-effectiveness of coronary artery calcium (CAC) score-guided statin therapy criteria and American College of Cardiology/American Heart Association (ACC/AHA) guidelines (10-year pooled cohort equation [PCE] risk ≥ 7.5%) with selection according to Australian guidelines (5-year absolute cardiovascular disease risk [ACVDR] ≥ 10%), for people with family histories of premature coronary artery disease. STUDY DESIGN,

settingMarkov microsimulation state transition model based on data from the Coronary Artery calcium score: Use to Guide management of Hereditary Coronary Artery Disease (CAUGHT-CAD) trial and transition probabilities derived from published statin prescribing and adherence outcomes and clinical data.

participants1083 people with family histories of premature coronary artery disease but no symptomatic cardiovascular disease.

main outcome measuresRelative cost-effectiveness over fifteen years, from the perspective of the Australian health care system, compared with usual care (Australian guidelines), assessed as incremental cost-effectiveness ratios (ICERs), with a notional willingness-to-pay threshold of $50 000 per quality-adjusted life-year (QALY) gained.

resultsApplying the Australian guidelines, 77 people were eligible for statin therapy (7.1%); with ACVDR 5-year risk ≥ 2% and CAC score > 0, 496 people (46%); with ACVDR 5-year risk ≥ 2% and CAC score ≥ 100, 155 people (14%); and with the ACC/AHA guidelines, 256 people (24%). The ICERs for CAC-guided selection were $33 108 (CAC ≥ 100) and $53 028 per QALY gained (CAC > 0); the ACC/AHA guidelines approach (ICER, $909 241 per QALY gained) was not cost-effective. CAC score-guided selection (CAC ≥ 100) was cost-effective for people with 5-year ACVDR of at least 5%.

conclusionExpanding the number of people at low to intermediate CVD risk eligible for statin therapy should selectively target people with subclinical atherosclerosis identified by CAC screening. This approach can be more cost-effective than simply lowering treatment eligibility thresholds.

Indexed as

Cardiovascular DiseasesCoronary Artery DiseaseHydroxymethylglutaryl-CoA Reductase InhibitorsAustraliaCalciumCost-Benefit AnalysisHumansRisk AssessmentRisk FactorsUnited StatesCalciumHydroxymethylglutaryl-CoA Reductase InhibitorsCholesterolComputed tomographyCoronary diseaseDiagnostic tests and proceduresPreventive medicine

Identifiers

PMID36841547
OpenAlexW4322011329

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.