Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery

Abstract

Objective To determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Design Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Data sources Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers.

A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

“…142-147 Recently, Henriksson et al 148 developed a new risk equation from a Swedish cohort and carried out external validation in a smaller UK data set of patients waiting for coronary artery surgery. A lifetime time horizon was used and risk of cardiovascular events was extrapolated from the Swedish data using a Markov model.…”

“…Although the authors recognise that the risk score requires further validation and refinement, this provides a useful example of how researchers might consider assessing cost-effectiveness of prognostic factors with decision models to enable prioritisation of patients waiting for treatment. 148 Importantly, the authors recognised several limitations that might be considered in further research; for example, the RR estimates for specific factors might be inflated because of publication bias or because of inadequate adjustment for the routinely recorded factors known to relate to prognostic factors and outcomes.…”

Tumour necrosis factor-α inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and economic evaluation

“…175,179 The CRP test cost is derived from Henriksson 2010. 180 Specialist visits are costed at £100 (outpatient rheumatology follow-up attendance), using the NHS Reference Costs 2012/13. …”

Increased Preoperative C-Reactive Protein Levels Are Associated with Inhospital Death After Coronary Artery Bypass Surgery

“…Our study assessed the value of preoperative CRP for predicting postoperative all-cause mortality in a relatively homogeneous patient population undergoing elective, CABG only surgery, and suggests that preoperative CRP is a significant discriminant of postoperative death. It is worth noting, though, that in a large prospective study, the addition of biomarkers, among them CRP, to the preoperative risk prediction model did not significantly improve the prediction of mortality over patient and disease characteristics alone [21]. In that study, the investigators concluded that the added measurement of biomarkers outside of preoperative risk factors would be an unnecessary use of health care resources with little added benefit for predicting inhospital mortality.…”