Clinical and economic efficiency of the coronary calcium score assessment in choosing a primary prevention strategy

Objective. Determination of the cost and clinical and economic efficiency of using the coronary calcium score (CCS) assessment for primary prevention with statin therapy using a decision-making model supplemented with CCS parameters and risk estimates from the SCORE and SCORE2 algorithms.

Methods. We assessed the clinical and economic efficiency of CCS measurement and statin therapy prescription based on a model supplemented with CCS parameters and risk estimates from the SCORE and SCORE2 algorithms. The study included 131 patients without symptomatic diseases caused by atherosclerosis. All patients underwent multispiral computed tomography with CCS assessment. A comparison of two primary prevention strategies was conducted, one of which was based only on the assessment of traditional risk factors (risk strategy), the second - taking into account the CCS.

Results. The comparison showed that the highest direct costs (10,988,419 rubles) were when using the risk strategy, and when using the strategy based on determining the CCS, they were 9.4% less (9,950,340 rubles). At the same time, the use of statins taking into account the CCS allows saving 2.2 times more funds due to the prevention of myocardial infarction and acute cerebrovascular accident. It is expected to spend 7,385,138 rubles on the treatment of complications in the risk group, and 3,386,761 rubles in the group with an assessment of the CCS. The use of statins using the generally accepted methodology would save 9.5 years without complications, taking into account the CCS – 9.7 years. Accordingly, the cost of 1 year of life without complications when using the risk strategy will be: CER = costs per 1 person for the entire period of treatment / 9.5 = 8,830 rubles, when assessing CCS - 7,831 rubles, and would also allow preserving 7.51 years of quality life, taking into account CCS – 7.54 years. Accordingly, the cost of 1 quality adjusted life year (QALY) when using the risk strategy will be: CUR = costs per 1 person for the entire period of treatment/7.51 = 11,169 rubles, taking into account CCS – 10,074 rubles; therefore, using the strategy taking into account CCS has the lowest cost of 1 QALY and is the most cost-effective. Sensitivity analysis showed that even when using the minimum or maximum cost definition of CCS, the results of the clinical economic analysis are robust, and the cost per 1 year of life without complications and per 1 QALY in patients who initiate statin therapy based on the CCS definition is lower than in patients taking statins based on the risk strategy.

Conclusion. CCS testing can be cost-effective, but only if the cost of the procedure is inexpensive.