Cost-effectiveness of CT screening to identify individuals at risk for cardiovascular events: a computer simulation study.
Projectomschrijving
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Samenvatting van de aanvraag
Coronary calcification can be considered a biomarker of atherosclerotic disease. CT screening for coronary calcifications identifies individuals at high risk of developing cardiovascular events in whom lifestyle advice and risk factor modification will be effective in reducing such events. Considerable uncertainty remains as to the cost-effectiveness of CT screening for coronary calcification and its effect on health care resource utilization.
Objective of the proposed study is to evaluate the cost-effectiveness, from the perspectives of the health care system and society at large, of CT screening for coronary calcifications compared to screening with risk scores based on established risk factors.
Specific research questions are:
1. Is additional CT screening for coronary calcifications cost-effective compared to screening based solely on the Framingham Risk Score, the European SCORE, or the Rotterdam Study prediction rule?
2. In which subgroups of individuals is CT screening for coronary calcifications cost-effective?
3. What threshold value of the CT coronary calcification score should be used in screening to ensure cost-effectiveness? Should this be an age- and sex-specific threshold?
We will develop a computer simulation model that replicates the natural history as observed in the Rotterdam Study, a prospective cohort follow-up study of 6871 adults aged 55 years and older. A systematic literature review will be performed to estimate the effectiveness of lifestyle advice, risk factor modification, treatment with aspirin, and combined interventions. Screening strategies using established risk factors, CT, or a combination of the two will be simulated defined by the screening method followed by different treatment strategies. We will analyze different thresholds above which treatment will be initiated for each screening strategy and analyze the effect of targeting various groups depending on their risk score based on established risk factors.