WITHDRAWN Cost-Effectiveness Analysis of Implementing a Polygenic Risk Score in a Workplace Cardiovascular Disease Prevention Program

OBJECTIVES: Adding a polygenic risk score (PRS) as an additional risk enhancing factor in current cardiovascular risk assessment models improves precision in assessing the risk of cardiovascular diseases and is cost-effective in a health system. However, the cost-effectiveness of PRS in a workplace cardiovascular prevention program is unknown.

METHODS: We developed a Markov model to project quality-adjusted life-years (QALYs) gained and incremental costs of a workplace cardiovascular prevention program that offered polygenic testing over a period of 5 years in a cohort of employees with a mean age of 50 years. Three programs were compared: 1) a workplace cardiovascular program that integrated PRS with the pooled cohort equation—standard of care for assessing the risk of cardiovascular diseases—(CardioriskSCORE); 2) a workplace cardiovascular prevention program without PRS (No-PRS); 3) no workplace health program (No-program). The model had 22 health states that reflected risk of disease (coronary artery disease and ischemic stroke) and statin prevention therapy side-effects (diabetes, hemorrhagic stroke and myopathy). We considered medical and lost productivity costs. Data came from the literature and the analysis was performed from a self-insured employer perspective with future costs and QALYs discounted at 3% annually. Uncertainty in model parameter inputs was assessed using deterministic and probabilistic sensitivity analyses.

RESULTS: CardioriskSCORE lowered employer costs ($53 and $575) and improved employee quality of life years (0.001 and 0.005) per employee screened compared to No-PRS and No-program, respectively. Effectiveness of statin prevention therapy, employee’s baseline cardiovascular risk, proportion of employees that enrolled in the program and statin adherence had the largest effects on the incremental net monetary benefit. However, despite the variation in parameter input values, base case results remained robust

CONCLUSIONS: Polygenic testing in a workplace cardiovascular prevention program improves employee quality of life and simultaneously lowers health costs and productivity monetary loss for employers.