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Cost Effectiveness of AtherosclerosisCost Effectiveness of Atherosclerosis
ScreeningScreening
Daniel B. Mark, MDDaniel B. ...
The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis:
The C...
The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis:
The P...
The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis:
The P...
The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis:
The A...
Assessing the Economics of Screening for AtheroscerosisAssessing the Economics of Screening for Atheroscerosis
The Two Key...
Cost Brings Discipline to the Practice of MedicineCost Brings Discipline to the Practice of Medicine
Choosing the Right Tool for the TaskChoosing the Right Tool for the Task
Impact of EBT on CV Risk Profile:Impact of EBT on CV Risk Profile:
Uniformed Services (Army) RCTUniformed Services (Army) ...
Uncoupling of Dx Testing and Outcome:Uncoupling of Dx Testing and Outcome:
How and Why?How and Why?
• Test provides “signi...
RCTs of Prevention with Statin Therapy:RCTs of Prevention with Statin Therapy:
Overview of 5-year Benefits and CostsOvervi...
Atherosclerosis Imaging in Preventive Cardiology:Atherosclerosis Imaging in Preventive Cardiology:
Will It Break the Bank?...
Screening for Atherosclerosis:Screening for Atherosclerosis:
The Ultimate ParadoxThe Ultimate Paradox
““Everyone wants to ...
Identifying High Risk of Sudden Cardiac Death:Identifying High Risk of Sudden Cardiac Death:
A Screening ParadoxA Screenin...
Economics of screening for atherosclerosis final
Economics of screening for atherosclerosis final
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Economics of screening for atherosclerosis final

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Economics of screening for atherosclerosis final

  1. 1. Cost Effectiveness of AtherosclerosisCost Effectiveness of Atherosclerosis ScreeningScreening Daniel B. Mark, MDDaniel B. Mark, MD Duke Clinical Research InstituteDuke Clinical Research Institute No relationships to discloseNo relationships to disclose
  2. 2. The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis: The Cardiac Imaging ExpertThe Cardiac Imaging Expert
  3. 3. The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis: The Practicing MDThe Practicing MD
  4. 4. The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis: The PatientThe Patient
  5. 5. The 4 Major Attitudes About Screening for Atherosclerosis:The 4 Major Attitudes About Screening for Atherosclerosis: The Academic ProfessorThe Academic Professor
  6. 6. Assessing the Economics of Screening for AtheroscerosisAssessing the Economics of Screening for Atheroscerosis The Two Key QuestionsThe Two Key Questions • Is the test strategy good value for $ ?Is the test strategy good value for $ ? (Cost effectiveness)(Cost effectiveness) • Do we have the money to provide itDo we have the money to provide it for our pts? ($ in health care budget)for our pts? ($ in health care budget)
  7. 7. Cost Brings Discipline to the Practice of MedicineCost Brings Discipline to the Practice of Medicine
  8. 8. Choosing the Right Tool for the TaskChoosing the Right Tool for the Task
  9. 9. Impact of EBT on CV Risk Profile:Impact of EBT on CV Risk Profile: Uniformed Services (Army) RCTUniformed Services (Army) RCT • 450 consecutive Army personnel, age 39-45450 consecutive Army personnel, age 39-45 • Randomized to EBT & case managementRandomized to EBT & case management (2 X 2 factorial)(2 X 2 factorial) • 15% had coronary calcium, mean 10 yr15% had coronary calcium, mean 10 yr Framingham risk 6%Framingham risk 6% • Over 1 yr, EBT arm showed no change inOver 1 yr, EBT arm showed no change in FRS relative to controlFRS relative to control O’Malley P et al.O’Malley P et al. JAMA 5/03JAMA 5/03
  10. 10. Uncoupling of Dx Testing and Outcome:Uncoupling of Dx Testing and Outcome: How and Why?How and Why? • Test provides “significant” new info thatTest provides “significant” new info that does not alter MD decisiondoes not alter MD decision • MDs do not agree on how to use testMDs do not agree on how to use test resultsresults • Indicated therapy not sufficiently effectiveIndicated therapy not sufficiently effective • Indicated therapy not applied effectivelyIndicated therapy not applied effectively
  11. 11. RCTs of Prevention with Statin Therapy:RCTs of Prevention with Statin Therapy: Overview of 5-year Benefits and CostsOverview of 5-year Benefits and Costs 11º Preventionº Prevention WOSCOPSWOSCOPS AFCAPSAFCAPS 2º Prevention2º Prevention CARECARE 4S4S DeathsDeaths 55 44 1111 3232 MIsMIs 1919 2626 1818 4747 RevascsRevascs 88 3131 4747 5959 RxRx $3700$3700 $4654$4654 $5550$5550 $4680$4680 OffsetOffset ↓↓$100$100 ↓↓$524$524 ↓↓$1660$1660 ↓↓$3900$3900 NetNet $3600$3600 $4130$4130 $3890$3890 $780$780 ↓↓ per 1000 ptsper 1000 pts Costs per ptCosts per pt Mark DB et al.Mark DB et al. Circ 08/02Circ 08/02
  12. 12. Atherosclerosis Imaging in Preventive Cardiology:Atherosclerosis Imaging in Preventive Cardiology: Will It Break the Bank?Will It Break the Bank? • If each farmer grazesIf each farmer grazes a few cattle, plenty ofa few cattle, plenty of grass for allgrass for all • If each farmer grazesIf each farmer grazes as many cattle asas many cattle as possible, grasspossible, grass rapidly depletedrapidly depleted The Tragedy of the Medical CommonsThe Tragedy of the Medical Commons
  13. 13. Screening for Atherosclerosis:Screening for Atherosclerosis: The Ultimate ParadoxThe Ultimate Paradox ““Everyone wants to go toEveryone wants to go to heaven but no one wantsheaven but no one wants to die.”to die.”
  14. 14. Identifying High Risk of Sudden Cardiac Death:Identifying High Risk of Sudden Cardiac Death: A Screening ParadoxA Screening Paradox 0.2% 1.5% 5.0% 20.0% 25.0% 0% 5% 10% 15% 20% 25% 30% 300,000 200,000 150,000 100,000 30,000 0 75000 150000 225000 300000 375000 Gen H-Risk Hx of EF<30% OutptGen H-Risk Hx of EF<30% Outpt Gen H-Risk Hx ofGen H-Risk Hx of EF<30% OutptEF<30% Outpt Pop CAD MI CHF SCD sur Pop CAD MI CHF SCD surPop CAD MI CHF SCD sur Pop CAD MI CHF SCD sur Incidence of SCD/yearIncidence of SCD/year Total events/yearTotal events/year

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