What is the Marginal Cost-Effectiveness of EBCT in an Asymptomatic Screening Population?
This presentation is the property of its rightful owner.
Sponsored Links
1 / 8

Allen J. Taylor MD,FACC Prospective Army Coronary Calcium (PACC) Project PowerPoint PPT Presentation


  • 83 Views
  • Uploaded on
  • Presentation posted in: General

What is the Marginal Cost-Effectiveness of EBCT in an Asymptomatic Screening Population? ( Compared to Conventional Risk Prediction). Allen J. Taylor MD,FACC Prospective Army Coronary Calcium (PACC) Project Walter Reed Army Medical Center, Washington, D.C.

Download Presentation

Allen J. Taylor MD,FACC Prospective Army Coronary Calcium (PACC) Project

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Allen j taylor md facc prospective army coronary calcium pacc project

What is the Marginal Cost-Effectiveness of EBCT in an Asymptomatic Screening Population? (Compared to Conventional Risk Prediction)

Allen J. Taylor MD,FACC

Prospective Army Coronary Calcium (PACC) Project

Walter Reed Army Medical Center, Washington, D.C.

Uniformed Services University, Bethesda, MD


Background

Background

  • Risk factors underestimate CVD risk

  • Screening EBCT Rationale:

    • Risk of CVD (4-fold) if Ca+ present

    • High % are “low risk” by risk factors

    • Potential to capture misclassificatied risk

  • Costs of screening for sub-clinical CVD are poorly understood


Base case assumptions

Base Case Assumptions

  • Life Expectancy (for average 40yo, 80%M)

    • “At Risk”: 35 years

    • “Low Risk”: 40 years

  • Utility of taking medications

    • 0.98

  • Efficacy of Primary Prevention

    • 30% RRR in mortality

  • EBCT CAC increases RR by 4


Results cost per quality adjusted life year

ResultsCost Per Quality-Adjusted Life Year

  • $90,000 per QALY for base case

  • “Expensive” by conventional standards

  • Most sensitive to the

    • Efficacy of primary prevention

    • Utility of taking life-long medications

    • Independent prognostic value of EBCT


Tornado diagram of important variables

Tornado Diagram of Important Variables

Efficacy of Primary Prevention

50% RR

10% RR

Utility on Medication

0.99

0.90

Incidental Finding

2%

20%

Cost of Medications

$100

$600

Cost of EBCT

$800

$200

10K

90K

200K +


Limitations

Limitations

  • Cost per case identified difficult to interpret

  • $$ per QALY requires many assumptions

    • Efficacy of risk identification not truly known

    • Prognostic value of calcification above conventional risk factor modeling is still controversial

  • Modeled 40yo asymptomatic population only

    • May not be generalizable to older populations


Conclusions

Conclusions

  • EBCT identifies a substantial number “at risk”, at a cost of $2990 per additional “at risk” case

  • The marginal COST/QALY is dependent on:

    • Value of CAC over FRI (>4-fold)

    • Cost and utility of medication (< $300/yr)

    • Incidental findings on EBCT (< 10%)

    • Efficacy of primary prevention (> 25% RRR)

  • Our base case using favorable assumptions indicated EBCT screening costs $75,000/QALY


Implications

Implications

  • Health systems, insurers and society need to understand the costs of new technologies that screen for coronary disease

  • Modeling can help assess the added value (or harm) of new technology where there is substantial uncertainty


  • Login