Study finds similar cost value of CAC testing, widespread statin treatment

When it comes to choosing whether to initiate statin treatment, similar clinical and economic consequences result if clinicians follow current guidelines or use coronary artery calcium (CAC) testing to guide that decision, according to new research.

The study, led by Jonathan C. Hong, with the Johns Hopkins Bloomberg School of Public Health in Baltimore, was published online Aug. 4 in the Journal of the American College of Cardiology. Both approaches led to similar costs and quality-adjusted life-years, according to the authors.

Measures of CAC provide valuable information for stratifying a patient’s risk for future coronary artery disease, and they can go beyond traditional risk stratification scores. A number of studies have shown that a significant proportion of those patients who are candidates for statin treatment under the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines have no detectable CAC.

In this regard, the authors cited a recent analysis that found that between 41 and 57 percent of people qualified for statin treatment under the ACC/AHA guidelines did not have any presence of CAC. Such individuals with no detectable CAC had few atherosclerotic cardiovascular disease events with a follow up of 10 years.

“Subsequently, these individuals have a lower 10-year observed atherosclerotic disease (ASCVD) risk than the threshold recommended for stain treatment,” wrote Hong et al.

 Specifically, the authors wrote, the absence of CAC leads to the assignment of individuals to a lower risk category, and such a reclassification can allow patients wider options in choosing whether or not to take stains.

The authors employed a microsimulation model to compare costs and effectiveness, taking a societal perspective and with a lifetime horizon. The model simulates both the economic and clinical consequences of ASCVD in a primary prevention setting for patients whose risk is intermediate.

In the statin-eligible population, CAC testing led to costs of $11,579 and quality-adjusted life-years (QALYs) of 11.859. Meanwhile, the treat-all strategy suggested by the guidelines led to costs of $11,498 and QALYs of 11.849.

It is the responsibility of clinicians, the authors stated to understand each patient’s personal preferences. “CAC testing can supplement the shared decision-making process through more accurate risk prediction and help avoid low-value pharmacological testing,” the researchers concluded.