Journal
ATHEROSCLEROSIS
Volume 317, Issue -, Pages 59-66Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2020.11.004
Keywords
Cardiovascular disease; Risk factors; Cost-effectiveness; Peripheral vascular disease
Funding
- Italian Ministry of University and Research (MIUR) - Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic)
- A. De Gasperis Cardiology and Cariac Surgery Foundation
- Italian Ministry of Health Ricerca Corrente-IRCCS MultiMedica
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This study evaluates the cost-effectiveness of ABI measurements in primary prevention in women and finds that adding ABI to FRS is a cost-effective approach, particularly in improving the accuracy of cardiovascular risk assessment in women.
Background and aims: Ankle brachial index (ABI) is a simple and cheap parameter to assess the presence of atherosclerosis. It could also help correctly reclassify the cardiovascular risk when added to the Framingham risk score (FRS). Recent evidence has demonstrated improvement in prediction performance of ABI when added to FRS, particularly in women. However, no studies have been published yet evaluating the cost-effectiveness of this approach. This study attempts to fill in this gap by assessing the cost-effectiveness of ABI measurements in primary prevention in women. Methods: We developed a Markov model to compare two different strategies for assessing the cardiovascular risk (low, intermediate and high) among women in the general population: 1) FRS strategy, and 2) FRS + ABI strategy; and the relative impact associated with interventions for preventing CV events in intermediate and high-risk categories. Results: In the base-case analysis, FRS + ABI reported an additional cost of Euro 110 and a gain of 0.0039 QALYs per patient, resulting in an ICER of (sic) 27.986/QALY, when compared to FRS alone. The ICER improved to (sic)1.641/QALY when using a lifetime horizon. The effectiveness of preventive CV disease interventions reported also a significant impact. A 32% reduction of CV events was the minimum value estimated to maintain FRS + ABI as a cost-effective strategy. Conclusions: The addition of ABI to FRS is a cost-effective approach in women classified at low and intermediate risk with FRS only. This new approach gives the possibility to reclassify and allocate them into the appropriate risk group and treatment.
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