The researchers then looked at which approaches met the threshold of costing no more than $50,000 per quality-adjusted-life-year, a common metric that takes into account quality of life as well as length of survival. (Therapies costing around $50,000 or less per quality-adjusted life-year are generally considered cost-effective.)
Their conclusion? Assigning statin therapy based on risk alone, without CRP testing, was the most cost-effective strategy. The optimal strategy for men with no risk factors, for example, would be to start a statin at the age of 55.
"Initiation of statin treatment at lower risk levels without CRP testing would further improve clinical outcomes at acceptable cost, making it the optimally cost-effective strategy in our analysis," the researchers wrote in their paper.
The researchers found, however, that the optimal strategy for prevention changed if the assumptions in the model were altered. For instance, if patients with normal CRP levels get little or no benefit from statin therapy, CRP screening would be the optimal strategy. And if harms from statin use are only slightly greater than currently thought, statin therapy would not be reasonable in low-risk individuals, and following current clinical guidelines would be the most cost-effective strategy.
Clearly, there are a lot of unknowns and assumptions - all of which tempered the researchers' conclusion. "This is not a slam-dunk decisi
|Contact: Michelle Brandt|
Stanford University Medical Center