Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis
Jedidiah I Morton, Florian Kronenberg, Magdalena Daccord, Nicola Bedlington, Marius Geantă, Tobias Silberzahn, Zhenyue Chen, Jean-Luc Eiselé, Bogi Eliasen, Mariko Harada‐Shiba, Marc Rijken, Albert Wiegman, George Thanassoulis, Pia R. Kamstrup, Iñaki Gutiérrez‐Ibarluzea, Pablo Coral, Raúl D. Santos, Erik S.G. Stroes, Michal Vrablı́k, Gerald F. Watts, Christie M. Ballantyne, Samia Mora, Børge G. Nordestgaard, Kausik K. Ray, Stephen J. Nicholls, Zanfina Ademi
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. 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. 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. CONCLUSIONS: Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.