Presentation (CTI)

OBJECTIVES: Cardiovascular diseases remain a leading cause of morbidity and mortality despite advances in prevention and treatment. Lipoprotein(a) [Lp(a)] is a largely genetically determined LDL-like particle associated with atherosclerotic cardiovascular disease and calcific aortic valve stenosis. Because Lp(a) levels remain relatively stable throughout life, once-in-a-lifetime testing can help identify individuals with increased lifetime cardiovascular risk. This analysis estimated the return on investment (ROI) of employer-funded Lp(a) testing among employees in Bulgaria from the employer payer perspective.
METHODS: ROI was assessed as the economic benefit generated through avoided revenue losses due to prevented cardiovascular events and deaths. A Microsoft Excel model combining a decision tree and Markov cohort structure was developed. Since the model did not reflect a specific company, inputs were based on average revenues and employee numbers among the top 100 companies in Bulgaria in 2024. The average annual company revenue was EUR 641,960,104, with an average workforce of 2,267 employees. The estimated annual revenue contribution per employee was EUR 283,176, or EUR 775 per day.
RESULTS: A one-time investment of EUR 26,188 for Lp(a) testing of all employees was projected to avoid company losses of EUR 77,502 within one year and EUR 361,317 over five years. This corresponded to a positive ROI of 196% in year one and 1,280% over five years. For every EUR 1 invested, the employer would receive EUR 2.96 within one year and EUR 13.80 over five years. The intervention was also projected to prevent 1.42 cardiovascular events and 0.30 deaths in one year, increasing to 7.1 events and 1.52 deaths over five years.
CONCLUSIONS: Employer-funded once-in-a-lifetime Lp(a) testing may generate substantial economic and social value as a preventive workplace health intervention in Bulgaria.