Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women

P.A. Cortesi, A. Maloberti, M. Micale, F. Pagliarin, I.C. Antonazzo, G. Mazzaglia, C. Giannattasio, L.G. Mantovani

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: Ankle brachial index (ABI) is a simple and cheap parameter to assess the presence of atherosclerosis. It could also help correctly reclassify the cardiovascular risk when added to the Framingham risk score (FRS). Recent evidence has demonstrated improvement in prediction performance of ABI when added to FRS, particularly in women. However, no studies have been published yet evaluating the cost-effectiveness of this approach. This study attempts to fill in this gap by assessing the cost-effectiveness of ABI measurements in primary prevention in women. Methods: We developed a Markov model to compare two different strategies for assessing the cardiovascular risk (low, intermediate and high) among women in the general population: 1) FRS strategy, and 2) FRS + ABI strategy; and the relative impact associated with interventions for preventing CV events in intermediate and high-risk categories. Results: In the base-case analysis, FRS + ABI reported an additional cost of € 110 and a gain of 0.0039 QALYs per patient, resulting in an ICER of € 27.986/QALY, when compared to FRS alone. The ICER improved to €1.641/QALY when using a lifetime horizon. The effectiveness of preventive CV disease interventions reported also a significant impact. A 32% reduction of CV events was the minimum value estimated to maintain FRS + ABI as a cost-effective strategy. Conclusions: The addition of ABI to FRS is a cost-effective approach in women classified at low and intermediate risk with FRS only. This new approach gives the possibility to reclassify and allocate them into the appropriate risk group and treatment. © 2020 Elsevier B.V.
Original languageEnglish
Pages (from-to)59-66
Number of pages8
JournalAtherosclerosis
Volume317
DOIs
Publication statusPublished - 2021

Keywords

  • Cardiovascular disease
  • Cost-effectiveness
  • Peripheral vascular disease
  • Risk factors

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