| Title: | Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis |
| Journal: | Atherosclerosis |
| Published: | 19 Aug 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41101894/ |
| DOI: | https://doi.org/10.1016/j.atherosclerosis.2025.120447 |
| URL: | https://www.atherosclerosis-journal.com/article/S0021-9150(25)01345-0/pdf |
Publication 16058
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Abstract
BACKGROUND AND AIMS: Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives.</p>
METHODS: We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level ≥105 nmol/L (50 mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA.</p>
RESULTS: Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and £263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis.</p>
CONCLUSIONS: Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.</p>
22 Keywords
- Adult
- Aged
- Australia
- Biomarkers
- Cardiovascular Diseases
- Cost-Benefit Analysis
- Cost-Effectiveness Analysis
- Developed Countries
- Female
- Health Care Costs
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Lipoprotein(a)
- Male
- Markov Chains
- Middle Aged
- Models, Economic
- Predictive Value of Tests
- Primary Prevention
- Quality-Adjusted Life Years
- Risk Assessment
- United Kingdom
27 Authors
- Jedidiah I. Morton
- Florian Kronenberg
- Magdalena Daccord
- Nicola Bedlington
- Marius Geanta
- Tobias Silberzahn
- Zhenyue Chen
- Jean-Luc Eisele
- Bogi Eliasen
- Mariko Harada-Shiba
- Marc Rijken
- Albert Wiegman
- George Thanassoulis
- Pia R. Kamstrup
- Iñaki Gutierrez-Ibarluzea
- Pablo Coral
- Raul D. Santos
- Erik Stroes
- Michal Vrablik
- Gerald F. Watts
- Christie M. Ballantyne
- Samia Mora
- Børge G. Nordestgaard
- Kausik K. Ray
- Stephen J. Nicholls
- Zanfina Ademi
- Lp International Taskforce initiative
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