The economic impact of implementing a multiple inflammatory biomarker-based approach to identify, treat, and reduce cardiovascular risk

Figures & data

Figure 1. Study design.

Table 1. Twelve-month CV-event incidence per 10,000 persons by gender and age*.

CV-event incidence	Male		Female
	Non-fatal MI	Non-fatal IS	Non-fatal MI	Non-fatal IS
25 ≤ age ≤34	3.6	8.4	1.4	7.7
35 ≤ age ≤44	7.1	16.8	2.8	15.4
45 ≤ age ≤54	20.0	33.5	9.7	30.9
55 ≤ age ≤64	114.0	43.0	32.0	22.0
65 ≤ age ≤74	119.0	111.0	57.0	70.0
75 ≤ age ≤84	228.0	196.0	110.0	171.0
Age 85+	245.0	162.0	173.0	271.0

*Incidence rates for persons aged 35–44 (MI only) and 45–54 were calculated by applying Census population estimates stratified by gender, age, and race to similarly stratified incidence estimates. As previously published incidence rates for persons aged 25–34 and 35–44 (IS only) were unavailable, these incidence rates were estimated to equal half the incidence among persons in the next oldest age bracket.

Table 2. Cost inputs.

Event-related 36-month cost per-patient	Costs, $*	Source
Non-fatal MI Non-fatal IS	$88,768 $42,492	O’Sullivan et al.12 (2011) Medicare Payment Advisory Commission13 (2013)
Annual per-patient cost of CVD-preventative prescription drugs
Statins†  Anti-hypertensives  Anti-diabetics Anti-coagulants	$135 $181 $680 $589	Analysis of pharmacy claims from 69 self-insured companies
Costs of monitoring and interventions
12-month per-patient cost of additional  monitoring after presence of abnormal biomarker	$250	Clinical guidance
Cost of cardiac intervention after biomarker testing  (5% of patients with abnormal Lp-PLA2 and MPO)	$37,723	Magnuson et al.19 (2013)

*All costs inflated to 2013 USD.

†Price reflects cost of generic statins.

Figure 2. Distribution of biomarker test results and relative risk ratios. Categories are mutually exclusive. HR indicates hazard ratio.

Table 3. Assumed biomarker testing rates by gender and age, column %.

Age groups	Biomarker testing
	Male	Female
25 ≤ age ≤34	0.0%	0.0%
35 ≤ age ≤44	10.0%	5.0%
45 ≤ age ≤54	50.0%	30.0%
55 ≤ age ≤64	80.0%	80.0%
65 ≤ age ≤74	90.0%	90.0%
75 ≤ age ≤84	40.0%	40.0%
Age 85+	20.0%	20.0%

Table 4. Estimated number of non-fatal MI and non-fatal IS events over 5 years.

CV event	SOC scenario	Biomarker testing scenario	Decrease in events
Non-fatal MI	21,104	19,065	2039
Non-fatal IS	22,589	20,719	1869

Table 5. Estimated change in related healthcare costs over 5 years, in $ thousands.

	SOC scenario	Biomarker testing scenario	Cost savings
Non-fatal MI	$1,696,530	$1,534,415	$162,115
Non-fatal IS	$920,478	$844,651	$75,827
Prescription drug use	$420,144	$438,872	−$18,729
Additional monitoring in response to abnormal biomarker(s)	$0	$15,656	−$15,656
Intervention in response to abnormal biomarker(s)	$0	$15,863	−$15,863
Overall	$3,037,152	$2,849,457	$187,695

Figure 3. Sensitivity of estimated healthcare cost savings to changes in base input values. *PMPM indicates per-member-per-month in reference to cost savings/increase resulting from adoption of biomarker testing. †Hazard ratios were not permitted to fall below one. ‡Biomarker test rates were not permitted to exceed 90%.

O’Sullivan AK, Rubin J, Nyambose J, et al. Cost estimation of cardiovascular disease events in the US. PharmacoEconomics 2011;29:693-704

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Medicare Payment Advisory Commission (MedPAC). Approaches to bundling payment for post-acute care. Report to Congress: Medicare and the health care delivery system. MedPAC, 2013. MedPAC.gov. Accessed June 2013

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Magnuson EA, Farkouh ME, Fuster V, et al. Cost-effectiveness of percutaneous coronary intervention with drug eluting stents versus bypass surgery for patients with diabetes mellitus and multivessel coronary artery disease: results from the FREEDOM trial. Circulation 2013;127:820-31

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