dc.description.abstract | OBJECTIVES: The use of lipids, lipoproteins, apolipoproteins
and high sensitive CRP (hs-CRP) in coronary artery disease
(CAD) diagnosis has been widely established, although cost-
effectiveness of these laboratory tests is not completely estab-
lished. METHODS: We constructed 4 models (models with low,
middle, high and very high risk for CAD, according to ATP III
recommendation). The diagnostic capabilities of laboratory test
combinations differs in terms of included markers: total choles-
terol (TC), triglycerides (TG), HDL-c, LDL-c, apolipoproteins B
and A-I (apo B and apo A-I), lipoprotein (a) (Lp(a)), apo(a) iso-
forms and hs-CRP for establishing risk of CAD. The effective-
ness of the laboratory test combinations, in number needed to
diagnose (NND), was established on the random sample of 221
CAD patients who were undergoing coronary angiography and
297 healthy subjects with no history of CAD. The direct medical
costs include price of test reagents and consumables specific to
each test, disposables need for specimen collection and sample
analysis, equipment amortization, and personal cost for labora-
tory technologist. ICER and two-way sensitivity analyses were
also calculated and applied. RESULTS: The cost per additional
successfully diagnosed patient for TC, HDL-c and LDL-c labo-
ratory test combination, were 2.4 and 35.4 euro (respectively),
lower than the cost of the TC, HDL-c, apoB in low and TC,
HDL-c, hs-CRP in very high risk groups. In high risk group, TC,
HDL-h, LDL-h had effectiveness 15% (100/NND) lower than
TC, HDL-c, hs-CRP, but overall saving was 11.9 euro. In middle
risk group TC, LDL-c, apo A-I was chosen as the best alterna-
tive. Such laboratory tests combination had effectiveness 17%
lower then TC, LDL-h and hs-CRP, but savings was 6.2 euro.
CONCLUSION: The cost-effectiveness analysis of different
diagnostic test combinations allows better selection of risky
patients at low cost for the society. | |