Using Stress Testing to Guide Primary Prevention of Coronary Heart Disease Among Intermediate-Risk Patients A Cost-Effectiveness Analysis

作者：Galper Benjamin Z^*; Moran Andrew; Coxson Pamela G; Pletcher Mark J; Heidenreich Paul; Lazar Lawrence D; Rodondi Nicolas; Wang Y Claire; Goldman Lee

来源：Circulation, 2012, 125(2): 260-U205.

DOI：10.1161/CIRCULATIONAHA.111.041293

• cost effectiveness
• prevention
• risk factors
• lipids

Background-Noninvasive stress testing might guide the use of aspirin and statins for primary prevention of coronary heart disease, but it is unclear if such a strategy would be cost effective. %26lt;br%26gt;Methods and Results-We compared the status quo, in which the current national use of aspirin and statins was simulated, with 3 other strategies: (1) full implementation of Adult Treatment Panel III guidelines, (2) a treat-all strategy in which all intermediate-risk persons received statins (men and women) and aspirin (men only), and (3) a test-and-treat strategy in which all persons with an intermediate risk of coronary heart disease underwent stress testing and those with a positive test were treated with high-intensity statins (men and women) and aspirin (men only). Healthcare costs, coronary heart disease events, and quality-adjusted life years from 2011 to 2040 were projected. Under a variety of assumptions, the treat-all strategy was the most effective and least expensive strategy. Stress electrocardiography was more effective and less expensive than other test-and-treat strategies, but it was less expensive than treat all only if statin cost exceeded $3.16/pill or if testing increased adherence from %26lt;22% to %26gt;75%. However, stress electrocardiography could be cost effective in persons initially nonadherent to the treat-all strategy if it raised their adherence to 5% and cost saving if it raised their adherence to 13%. %26lt;br%26gt;Conclusions-When generic high-potency statins are available, noninvasive cardiac stress testing to target preventive medications is not cost effective unless it substantially improves adherence. (Circulation. 2012;125:260-270.)

• 出版日期2012-1-17