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A Multimarker Approach for the Prediction of Coronary Artery Disease: Cost-Effectiveness Analysis

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2010
1331.pdf (258.3Kb)
Authors
Lakić, Dragana
Bogavac-Stanojević, Nataša
Jelić-Ivanović, Zorana
Kotur-Stevuljević, Jelena
Spasić, Slavica
Kos, Mitja
Article (Published version)
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Abstract
Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic burden on health-care systems. We used a multi-marker approach to explore discriminative abilities of several lipid, inflammatory, and oxidative stress/antioxidative defense markers as CAD predictors. We assessed their cost-effectiveness compared with the Framingham risk score (FRS). Methods: Using a decision model, we evaluated the costs, accuracy, and cost-effectiveness of each model. The FRS was used as the baseline model. Other models were formed with the consecutive addition of selected markers: apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), apolipoprotein (a) [apo(a)] isoform, lipoprotein (a), high-sensitivity C-reactive protein, malondialdehyde, superoxide dismutase (SOD), sulfhydryl, and superoxide anion (O-2-). A best-case model was formed from a combination of diagnostic markers to yield the best patient stratification algorithm. All models were assessed by their predictive ...probabilities using receiver operating characteristic curves. To accomplish our goals, we recruited 188 CAD patients (verified by coronary angiography) and 197 asymptomatic CAD-free subjects for comparison. The analysis was performed from a third-party payer perspective. Results: Only two strategies had outstanding discriminative abilities: the best-case model (FRS, SOD, and O-2-) and FRS plus SOD with area under the curve (AUC) values of 0.924 and 0.906, respectively. The cost-effectiveness ratio varied between 593 per AUC for the baseline model to 2425 per AUC for FRS plus apo(a) isoform. Strategies involving oxidative stress/antioxidative defense markers were more cost-effective than strategies involving lipid or inflammatory markers. All results were robust. Conclusion: Our results support the feasibility of a multimarker approach for CAD screening. The introduction of oxidative stress/antioxidative defense markers in the clinical laboratory would be convenient and cost-effective.

Keywords:
coronary artery disease / cost-effectiveness / multimarker approach / risk prediction
Source:
Value in Health, 2010, 13, 6, 770-777
Publisher:
  • Elsevier Science Inc
Funding / projects:
  • Ispitivanje biohemijskih i genetičkih faktora rizika kao uzročnika i markera ateroskleroze i drugih oboljenja: analitički i klinički aspekti (RS-145036)

DOI: 10.1111/j.1524-4733.2010.00769.x

ISSN: 1098-3015

PubMed: 20667056

WoS: 000281666700011

Scopus: 2-s2.0-77956360726
[ Google Scholar ]
7
5
URI
https://farfar.pharmacy.bg.ac.rs/handle/123456789/1333
Collections
  • Radovi istraživača / Researchers’ publications
Institution/Community
Pharmacy
TY  - JOUR
AU  - Lakić, Dragana
AU  - Bogavac-Stanojević, Nataša
AU  - Jelić-Ivanović, Zorana
AU  - Kotur-Stevuljević, Jelena
AU  - Spasić, Slavica
AU  - Kos, Mitja
PY  - 2010
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/1333
AB  - Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic burden on health-care systems. We used a multi-marker approach to explore discriminative abilities of several lipid, inflammatory, and oxidative stress/antioxidative defense markers as CAD predictors. We assessed their cost-effectiveness compared with the Framingham risk score (FRS). Methods: Using a decision model, we evaluated the costs, accuracy, and cost-effectiveness of each model. The FRS was used as the baseline model. Other models were formed with the consecutive addition of selected markers: apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), apolipoprotein (a) [apo(a)] isoform, lipoprotein (a), high-sensitivity C-reactive protein, malondialdehyde, superoxide dismutase (SOD), sulfhydryl, and superoxide anion (O-2-). A best-case model was formed from a combination of diagnostic markers to yield the best patient stratification algorithm. All models were assessed by their predictive probabilities using receiver operating characteristic curves. To accomplish our goals, we recruited 188 CAD patients (verified by coronary angiography) and 197 asymptomatic CAD-free subjects for comparison. The analysis was performed from a third-party payer perspective. Results: Only two strategies had outstanding discriminative abilities: the best-case model (FRS, SOD, and O-2-) and FRS plus SOD with area under the curve (AUC) values of 0.924 and 0.906, respectively. The cost-effectiveness ratio varied between 593 per AUC for the baseline model to 2425 per AUC for FRS plus apo(a) isoform. Strategies involving oxidative stress/antioxidative defense markers were more cost-effective than strategies involving lipid or inflammatory markers. All results were robust. Conclusion: Our results support the feasibility of a multimarker approach for CAD screening. The introduction of oxidative stress/antioxidative defense markers in the clinical laboratory would be convenient and cost-effective.
PB  - Elsevier Science Inc
T2  - Value in Health
T1  - A Multimarker Approach for the Prediction of Coronary Artery Disease: Cost-Effectiveness Analysis
VL  - 13
IS  - 6
SP  - 770
EP  - 777
DO  - 10.1111/j.1524-4733.2010.00769.x
ER  - 
@article{
author = "Lakić, Dragana and Bogavac-Stanojević, Nataša and Jelić-Ivanović, Zorana and Kotur-Stevuljević, Jelena and Spasić, Slavica and Kos, Mitja",
year = "2010",
abstract = "Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic burden on health-care systems. We used a multi-marker approach to explore discriminative abilities of several lipid, inflammatory, and oxidative stress/antioxidative defense markers as CAD predictors. We assessed their cost-effectiveness compared with the Framingham risk score (FRS). Methods: Using a decision model, we evaluated the costs, accuracy, and cost-effectiveness of each model. The FRS was used as the baseline model. Other models were formed with the consecutive addition of selected markers: apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), apolipoprotein (a) [apo(a)] isoform, lipoprotein (a), high-sensitivity C-reactive protein, malondialdehyde, superoxide dismutase (SOD), sulfhydryl, and superoxide anion (O-2-). A best-case model was formed from a combination of diagnostic markers to yield the best patient stratification algorithm. All models were assessed by their predictive probabilities using receiver operating characteristic curves. To accomplish our goals, we recruited 188 CAD patients (verified by coronary angiography) and 197 asymptomatic CAD-free subjects for comparison. The analysis was performed from a third-party payer perspective. Results: Only two strategies had outstanding discriminative abilities: the best-case model (FRS, SOD, and O-2-) and FRS plus SOD with area under the curve (AUC) values of 0.924 and 0.906, respectively. The cost-effectiveness ratio varied between 593 per AUC for the baseline model to 2425 per AUC for FRS plus apo(a) isoform. Strategies involving oxidative stress/antioxidative defense markers were more cost-effective than strategies involving lipid or inflammatory markers. All results were robust. Conclusion: Our results support the feasibility of a multimarker approach for CAD screening. The introduction of oxidative stress/antioxidative defense markers in the clinical laboratory would be convenient and cost-effective.",
publisher = "Elsevier Science Inc",
journal = "Value in Health",
title = "A Multimarker Approach for the Prediction of Coronary Artery Disease: Cost-Effectiveness Analysis",
volume = "13",
number = "6",
pages = "770-777",
doi = "10.1111/j.1524-4733.2010.00769.x"
}
Lakić, D., Bogavac-Stanojević, N., Jelić-Ivanović, Z., Kotur-Stevuljević, J., Spasić, S.,& Kos, M.. (2010). A Multimarker Approach for the Prediction of Coronary Artery Disease: Cost-Effectiveness Analysis. in Value in Health
Elsevier Science Inc., 13(6), 770-777.
https://doi.org/10.1111/j.1524-4733.2010.00769.x
Lakić D, Bogavac-Stanojević N, Jelić-Ivanović Z, Kotur-Stevuljević J, Spasić S, Kos M. A Multimarker Approach for the Prediction of Coronary Artery Disease: Cost-Effectiveness Analysis. in Value in Health. 2010;13(6):770-777.
doi:10.1111/j.1524-4733.2010.00769.x .
Lakić, Dragana, Bogavac-Stanojević, Nataša, Jelić-Ivanović, Zorana, Kotur-Stevuljević, Jelena, Spasić, Slavica, Kos, Mitja, "A Multimarker Approach for the Prediction of Coronary Artery Disease: Cost-Effectiveness Analysis" in Value in Health, 13, no. 6 (2010):770-777,
https://doi.org/10.1111/j.1524-4733.2010.00769.x . .

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