Cost-Effectiveness of Using High-Sensitivity C-Reactive Protein to Identify Intermediate- and Low-Cardiovascular-Risk Individuals for Statin Therapy

K. K. Lee, L. E. Cipriano, D. K. Owens, A. S. Go, M. A. Hlatky
2010 Circulation  
Background-Many myocardial infarctions and strokes occur in individuals with low-density lipoprotein cholesterol levels below recommended treatment thresholds. High sensitivity C-reactive protein (hs-CRP) testing has been advocated to identify low-and intermediate-risk individuals who may benefit from statin therapy. Methods and Results-A decision analytic Markov model was used to follow hypothetical cohorts of individuals with normal lipid levels but without coronary artery disease, peripheral
more » ... disease, peripheral arterial disease, or diabetes mellitus. The model compared current Adult Treatment Panel III practice guidelines, a strategy of hs-CRP screening in those without an indication for statin treatment by current practice guidelines followed by treatment only in those with elevated hs-CRP levels, and a strategy of statin therapy at specified predicted risk thresholds without hs-CRP testing. Risk-based treatment without hs-CRP testing was the most cost-effective strategy, assuming that statins were equally effective regardless of hs-CRP status. However, if normal hs-CRP levels identified a subgroup with little or no benefit from statin therapy (Ͻ20% relative risk reduction), then hs-CRP screening would be the optimal strategy. If harms from statin use were greater than generally recognized, then use of current clinical guidelines would be the optimal strategy. Conclusion-Risk-based statin treatment without hs-CRP testing is more cost-effective than hs-CRP screening, assuming that statins have good long-term safety and provide benefits among low-risk people with normal hs-CRP. (Circulation.
doi:10.1161/circulationaha.110.947960 pmid:20876434 fatcat:obtr3vau6rbfdo5grlld4ehxju