Cost-effectiveness analysis of coronary artery disease screening in HIV-infected men.

ABSTRACT: HIV-infected patients are at increased risk of coronary artery disease (CAD). We evaluated the cost-effectiveness of cardiac screening for HIV-positive men at intermediate or greater CAD risk.We developed a lifetime microsimulation model of CAD incidence and progression in HIV-infected men.Input parameters were derived from two HIV cohort studies and the literature. We compared no CAD screening with stress testing and coronary computed tomography angiography (CCTA)-based strategies. Patients with test results indicating 3-vessel/left main CAD underwent invasive coronary angiography (ICA) and received coronary artery bypass graft surgery. In the stress testing + medication and CCTA?+ medication strategies, patients with 1-2-vessel CAD results received lifetime medical treatment without further diagnostics whereas in the stress testing + intervention and CCTA?+ intervention strategies, patients with these results underwent ICA and received percutaneous coronary intervention.Compared to no screening, the stress testing + medication, stress testing + intervention, CCTA?+ medication, and CCTA?+ intervention strategies resulted in 14, 11, 19, and 14 quality-adjusted life days per patient and incremental cost-effectiveness ratios of 49,261, 57,817, 34,887 and 56,518 Euros per quality-adjusted life year (QALY), respectively. Screening only at higher CAD risk thresholds was more cost-effective. Repeated screening was clinically beneficial compared to one-time screening, but only stress testing + medication every 5 years remained cost-effective. At a willingness-to-pay threshold of 83,000 €/QALY (? 100,000 US$/QALY), implementing any CAD screening was cost-effective with a probability of 75-95%.Screening HIV-positive men for CAD would be clinically beneficial and comes at a cost-effectiveness ratio comparable to other accepted interventions in HIV care.

SUBMITTER: Nolte JE 

PROVIDER: S-EPMC3841232 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature