Krstačić Goran, Jülicher Paul, Krstačić Antonija, Varounis Christos
Institute for Cardiovascular Prevention and Rehabilitation (Srčana), Zagreb, Croatia.
J. J. Strossmayer University of Osijek Faculty of Dental Medicine and Health, Osijek, Croatia.
Int J Cardiol Cardiovasc Risk Prev. 2024 Feb 10;20:200244. doi: 10.1016/j.ijcrp.2024.200244. eCollection 2024 Mar.
To estimate the effectiveness and cost-effectiveness of a high-sensitivity troponin I (hsTnI) guided cardiovascular risk assessment program in women in Croatia.
An observational study of a voluntary program for cardiovascular disease (CVD) risk assessment in women aged above 45 years with no specific symptoms, no confirmed or known coronary artery disease was conducted (WHP). Participants were stratified into three categories according to their hsTnI level. Subjects in the moderate or high-risk class were referred to cardiac work-up and invasive cardiovascular investigation as appropriate. Study information were applied to a discrete-event simulation model to estimate the cost-effectiveness of WHP against current practice. The number of CVD events and deaths, costs, and quality-adjusted life years (QALY) were assessed over 10 years from a societal perspective.
Of 1034 women who participated in the program, 921 (89.1%), 100 (9.7%), and 13 (1.3%) subjects fall into the low, moderate, and high-risk class. Of 26 women referred for angiography, significant coronary artery disease (CAD) was diagnosed in 12 women (46.1%). WHP gained 15.8 (95%CI 12.8; 17.2) QALYs per 1000 subjects, increased costs by 490€ (95%CI 487; 500), decreased CVD-related mortality by 40%. At a willingness-to-pay threshold of 45,000 €/QALY, WHP was cost-effective with a probability of 90%. Model results were most sensitive to utility weights and cost of medical prevention.
Assessing the cardiovascular risk in asymptomatic women with hsTnI and guiding those at higher risk to further cardiac testing, identified individuals with CAD, could reduce CVD related burden, and would be cost-effective.
评估高敏肌钙蛋白I（hsTnI）指导的心血管风险评估项目在克罗地亚女性中的有效性和成本效益。
对一项针对45岁以上无特定症状、无确诊或已知冠状动脉疾病的女性进行心血管疾病（CVD）风险评估的自愿项目进行观察性研究（WHP）。参与者根据其hsTnI水平分为三类。中度或高危类别的受试者被转介进行心脏检查和适当的侵入性心血管检查。将研究信息应用于离散事件模拟模型，以评估WHP相对于当前实践的成本效益。从社会角度评估10年内的CVD事件和死亡人数、成本以及质量调整生命年（QALY）。
在参与该项目的1034名女性中，921名（89.1%）、100名（9.7%）和13名（1.3%）受试者分别属于低、中、高危类别。在26名接受血管造影的女性中，12名女性（46.1%）被诊断为严重冠状动脉疾病（CAD）。WHP每1000名受试者获得15.8（95%CI 12.8；17.2）个QALY，成本增加490欧元（95%CI 487；500），CVD相关死亡率降低40%。在每QALY支付意愿阈值为45,000欧元时，WHP具有成本效益的概率为90%。模型结果对效用权重和医疗预防成本最为敏感。
用hsTnI评估无症状女性的心血管风险，并指导高危人群进行进一步的心脏检查，识别出患有CAD的个体，可以减轻CVD相关负担，并且具有成本效益。
