TEST, TARGET, TREAT: COST-EFFECTIVENESS OF HSCRP-GUIDED TREATMENT IN PEOPLE WITH ATHEROSCLEROTIC CARDIOVASCULAR DISEASE AND CHRONIC KIDNEY DISEASE IN SWEDEN
Author(s)
Phillip A. Kittel, M.Sc.1, Brigitta Monz, MA, MPH, MD2, Diana Teloian, MA3.
1Roche Diagnostics Ltd, Rotkreuz, Switzerland, 2Roche Diagnostics GmbH, Mannheim, Germany, 3Parexel International, Tblisi, Georgia.
1Roche Diagnostics Ltd, Rotkreuz, Switzerland, 2Roche Diagnostics GmbH, Mannheim, Germany, 3Parexel International, Tblisi, Georgia.
OBJECTIVES: Patients with atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) face cardiovascular (CV) inflammation, identifiable via elevated high-sensitivity C-reactive protein (hsCRP ≥2 mg/L). CV inflammation is a prognostic marker for future cardiovascular events and is therapeutically modifiable. Several medical associations therefore recently started recommending hsCRP risk stratification. However, no cost-effectiveness analyses have evaluated hsCRP-guided treatment modifications in ASCVD+CKD populations. This study investigated the cost-effectiveness of hsCRP-guided statin treatment initiation in these currently statin-untreated patients.
METHODS: A lifetime decision-analytic model (decision tree and Markov cohort) from a Swedish payer perspective compared a cohort with standard of care (no hsCRP testing; maintaining 54.9% statin use in CV inflammation positive [SI+] patients) with a cohort of universal hsCRP testing (targeting 90% statin use in SI+ patients). Health states included stable ASCVD, non-fatal myocardial infarction, non-fatal ischemic stroke, cardiovascular, and non-cardiovascular death. Inputs were derived from literature and Swedish registries; costs (2026 SEK) and quality-adjusted life-years (QALYs) were discounted at 3%. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were conducted.
RESULTS: The hsCRP testing strategy was dominant, yielding cost savings of 17,534 SEK and 0.076 additional QALYs per patient. DSA demonstrated that hsCRP testing remained dominant across all parameters tested, indicating robust cost-effectiveness. The relative risk for major adverse cardiovascular events comparing statin-treated versus statin-untreated patients was the major model driver. Additional variables tested in the DSA were e.g. the SI+ prevalence and baseline statin treatment rate, demonstrating the robustness of the model results over a wide range of these parameters. The PSA confirmed a 97.7% probability that hsCRP testing is dominant.
CONCLUSIONS: hsCRP-guided statin treatment initiation is a cost-saving strategy that improves health outcomes in SI+ ASCVD+CKD patients. Implementing routine testing effectively addresses CV inflammation and closes clinical treatment gaps in this high-risk population.
METHODS: A lifetime decision-analytic model (decision tree and Markov cohort) from a Swedish payer perspective compared a cohort with standard of care (no hsCRP testing; maintaining 54.9% statin use in CV inflammation positive [SI+] patients) with a cohort of universal hsCRP testing (targeting 90% statin use in SI+ patients). Health states included stable ASCVD, non-fatal myocardial infarction, non-fatal ischemic stroke, cardiovascular, and non-cardiovascular death. Inputs were derived from literature and Swedish registries; costs (2026 SEK) and quality-adjusted life-years (QALYs) were discounted at 3%. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were conducted.
RESULTS: The hsCRP testing strategy was dominant, yielding cost savings of 17,534 SEK and 0.076 additional QALYs per patient. DSA demonstrated that hsCRP testing remained dominant across all parameters tested, indicating robust cost-effectiveness. The relative risk for major adverse cardiovascular events comparing statin-treated versus statin-untreated patients was the major model driver. Additional variables tested in the DSA were e.g. the SI+ prevalence and baseline statin treatment rate, demonstrating the robustness of the model results over a wide range of these parameters. The PSA confirmed a 97.7% probability that hsCRP testing is dominant.
CONCLUSIONS: hsCRP-guided statin treatment initiation is a cost-saving strategy that improves health outcomes in SI+ ASCVD+CKD patients. Implementing routine testing effectively addresses CV inflammation and closes clinical treatment gaps in this high-risk population.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE319
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Urinary/Kidney Disorders