Coronary artery calcium (CAC) screening is a computed tomography (CT) scan of the heart that shows calcium buildup in the coronary arteries. This test provides a numbered score based on the amount of calcium present, with a higher score signifying a higher risk of cardiovascular disease (CVD). At present, CAC testing is not commonly used in routine clinical practice and its cost-effectiveness compared to other treatment strategies for patients at intermediate risk of CVD is not well established in Canada. As such, a recent publication in JACC: Advances sought to address this important issue.
The researchers utilized a health economics model to simulate the clinical and economic consequences of CVD primary prevention strategies in a hypothetical group of 10,000 patients from a Canadian publicly funded health care system perspective. This model compared two treatment strategies: (1) a universal statin treatment where all individuals received high-intensity statins, and (2) CAC testing, where those with a score of zero received no treatment, and those with a score of 1 or greater received high-intensity statins. Outcomes from the simulation were analyzed at 5- and 10-year markers.
The study found that CAC score-guided treatment compared to universal statins was estimated to be marginally cost-neutral at 5 years and cost-effective at 10 years. The researchers emphasize the need for increased availability of low-cost CAC screening in order to ensure that it is a more widely accessible option for informing treatment decisions on statin therapy.
“It was a delight to work closely with Ms. Hena Qureshi and Dr. Padma Kaul to execute this complex, collaborative work with our USA colleagues from MESA,” says senior author Dr. G. B. John Mancini. “The analysis puts into perspective a gap in risk stratification in Canada. Use of CAC screening at an appropriate cost point, particularly in patients who are statin-reluctant or statin-intolerant and who would benefit from statin therapy, is an important clinical tool for reducing CV risk in Canada.”
This paper was led by the CVC (Hena Qureshi, MSc, Padma Kaul, PhD, and Douglas Dover, PhD) in collaboration with the Canadian Cardiovascular Research Collaboratory (C3) investigator and senior author G. B. John Mancini, MD (University of British Columbia), and Multi-Ethnic Study of Atherosclerosis (MESA) investigators Michael Blaha, MD, MPH (John Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease), and Brandon Bellows, PharmD, MS (Columbia University).
