Presented by Mark Pletcher, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.

1. Cost-effectiveness of coronary calcium testing to guide statin therapy: Preliminary Results CVD Risk Biomarker Symposium Mark J. Pletcher, MD, MPH 1/30/2012

3. The CAC version of the model

4. Key Inputs

9. 45 yo man with 5% risk Statins = $0.13 / day 10-year horizon Preliminary Results

10. 45 yo man with 5% risk Steeper “slope” (good - depends of CAC RR) Shifted to the right (bad – depends on CAC $) Medium effectiveness (depends on # treated, prev of CAC) Statins = $0.13 / day 10-year horizon Preliminary Results

11. 45 yo man with 5% risk Cost-effectiveness “frontier” (i.e., Non-dominated strategies) Statins = $0.13 / day 10-year horizon Preliminary Results

12. 45 yo man with 5% risk ICER for non-dominated strategies $152,000 $57,000 Statins = $0.13 / day 10-year horizon Preliminary Results

13. 45 yo man with 5% risk If willingness to pay <$50,000/QALY, Preferred strategy = Treat none $152,000 $57,000 Statins = $0.13 / day 10-year horizon Preliminary Results

14. 45 yo man with 15% risk Statins = $0.13 / day 10-year horizon Preliminary Results

15. 45 yo man with 10% risk Statins = $0.13 / day 10-year horizon $25,000/QALY Preliminary Results

16. 45 yo man with 7.5% risk $55,000/QALY $8,000/QALY Preliminary Results

19. 65 yo man with 7.5% risk $15,000/QALY $8,000/QALY $78,000/QALY Preliminary Results

22. 65 yo Woman with 7.5% risk $18,000/QALY $59,000/QALY Preliminary Results

32. Base Case $16,000/QALY $126,000/QALY Preliminary Results

33. If cost of scan = $300 Preliminary Results

34. If CAC is half as useful $24/QALY $37,000/QALY Preliminary Results