OBJECTIVES: Elevated Lipoprotein (a) [Lp(a)] is a genetically inherited condition that has been causally associated with an increased risk for cardiovascular disease (CVD). Despite guidelines recommendation of broad Lp(a) testing, this is not implemented in real-world clinical practice. Absence of targeted therapies and economic concerns have been indicated as barriers on general Lp(a) testing. This study aims to assess the cost-effectiveness and budget impact of implementing Lp(a) testing for secondary prevention in an atherosclerotic cardiovascular disease (ASCVD) population in absence of targeted therapies, adopting the perspective of the Portuguese National Health Service (P-NHS).

METHODS: A decision tree economic model followed by a Markov model and the UK Biobank’s (UKBK) predictive risk equations were used to develop the economic model. The costs and outcomes with and without Lp(a) testing were compared, with the assumption that testing might induce a behavioral change which in turn might impact other cardiovascular (CV) risk factors.

RESULTS: Different scenarios were considered, and Lp(a) testing is deemed to be a cost-effective strategy in most of the scenarios with a minimal change (< 2%) in two CV risk factors. When considering a sizeable change in a single CV risk factor such as LDL-C as previously observed, Lp(a) testing is dominant. In this scenario, the budget impact model showed that testing was able to generate cost savings in a Portuguese secondary prevention ASCVD population.

CONCLUSIONS: Testing for Lp(a) in a secondary prevention population can be a cost-effective approach. When considering a significant change in CV risk factors, testing can be cost saving, potentially leading to relevant benefits to the P-NHS, even in the absence of target therapies. Although Lp(a) testing may contribute towards an optimization of CV risk management, the unmet need of reducing Lp(a) associated CV risk remains.