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. 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 <22% to >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%. 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.
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. 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 <22% to >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%. 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.
Authors: Thomas C Gerber; J Jeffrey Carr; Andrew E Arai; Robert L Dixon; Victor A Ferrari; Antoinette S Gomes; Gary V Heller; Cynthia H McCollough; Michael F McNitt-Gray; Fred A Mettler; Jennifer H Mieres; Richard L Morin; Michael V Yester Journal: Circulation Date: 2009-02-02 Impact factor: 29.690
Authors: C Baigent; A Keech; P M Kearney; L Blackwell; G Buck; C Pollicino; A Kirby; T Sourjina; R Peto; R Collins; R Simes Journal: Lancet Date: 2005-09-27 Impact factor: 79.321
Authors: Thomas Thom; Nancy Haase; Wayne Rosamond; Virginia J Howard; John Rumsfeld; Teri Manolio; Zhi-Jie Zheng; Katherine Flegal; Christopher O'Donnell; Steven Kittner; Donald Lloyd-Jones; David C Goff; Yuling Hong; Robert Adams; Gary Friday; Karen Furie; Philip Gorelick; Brett Kissela; John Marler; James Meigs; Veronique Roger; Stephen Sidney; Paul Sorlie; Julia Steinberger; Sylvia Wasserthiel-Smoller; Matthew Wilson; Philip Wolf Journal: Circulation Date: 2006-01-11 Impact factor: 29.690
Authors: Paul Erne; Andreas W Schoenenberger; Michel Zuber; Dieter Burckhardt; Wolfgang Kiowski; Paul Dubach; Therese Resink; Matthias Pfisterer Journal: Eur Heart J Date: 2007-07-19 Impact factor: 29.983
Authors: Ruth E Bates; Mohamed Omer; Sahar S Abdelmoneim; Adelaide M Arruda-Olson; Christopher G Scott; Kent R Bailey; Robert B McCully; Patricia A Pellikka Journal: Mayo Clin Proc Date: 2016-10-06 Impact factor: 7.616
Authors: Aline M A Martins; Mariana U B Paiva; Diego V N Paiva; Raphaela M de Oliveira; Henrique L Machado; Leonardo J S R Alves; Carolina R C Picossi; Andréa T Faccio; Marina F M Tavares; Coral Barbas; Viviane Z R Giraldez; Raul D Santos; Guilherme U Monte; Fernando A Atik Journal: Front Cardiovasc Med Date: 2021-12-22