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Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men.
Nolte, Julia E H; Neumann, Till; Manne, Jennifer M; Lo, Janet; Neumann, Anja; Mostardt, Sarah; Abbara, Suhny; Hoffmann, Udo; Brady, Thomas J; Wasem, Juergen; Grinspoon, Steven K; Gazelle, G Scott; Goehler, Alexander.
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  • Nolte JE; Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
  • Neumann T; West German Heart Institute, University of Duisburg-Essen, Essen, Germany.
  • Manne JM; Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
  • Lo J; Program in Nutritional Metabolism, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
  • Neumann A; Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
  • Mostardt S; Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
  • Abbara S; Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
  • Hoffmann U; Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
  • Brady TJ; Cardiac MR, PET, CT Program, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
  • Wasem J; Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany.
  • Grinspoon SK; Program in Nutritional Metabolism, Massachusetts General Hospital & Harvard Medical School, Boston, USA.
  • Gazelle GS; Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, USA.
  • Goehler A; Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, USA Alfried Krupp von Bohlen und Halbach Foundation-Institute for Health Systems Management, University of Duisburg-Essen, Essen, Germany Cardiac MR, PET, CT Program, De
Eur J Prev Cardiol ; 21(8): 972-9, 2014 Aug.
Article en En | MEDLINE | ID: mdl-23539717
BACKGROUND: HIV-infected patients are at increased risk of coronary artery disease (CAD). We evaluated the cost-effectiveness 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 (∼ 100,000 US$/QALY), implementing any CAD screening was cost-effective 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Tomografía Computarizada por Rayos X / Infecciones por VIH / Tamizaje Masivo / Angiografía Coronaria / Ecocardiografía de Estrés / Electrocardiografía Tipo de estudio: Diagnostic_studies / Etiology_studies / Health_economic_evaluation / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Screening_studies Aspecto: Patient_preference Límite: Adult / Humans / Male / Middle aged Idioma: En Revista: Eur J Prev Cardiol Año: 2014 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Tomografía Computarizada por Rayos X / Infecciones por VIH / Tamizaje Masivo / Angiografía Coronaria / Ecocardiografía de Estrés / Electrocardiografía Tipo de estudio: Diagnostic_studies / Etiology_studies / Health_economic_evaluation / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Screening_studies Aspecto: Patient_preference Límite: Adult / Humans / Male / Middle aged Idioma: En Revista: Eur J Prev Cardiol Año: 2014 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido