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PubMed · 41101894

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 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(a) International Taskforce (ITF) initiative
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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. 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.

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HumansCost-Benefit AnalysisCardiovascular DiseasesLipoprotein(a)Primary PreventionMiddle AgedAgedMaleFemaleAdultMarkov ChainsQuality-Adjusted Life YearsBiomarkersModels, EconomicDeveloped CountriesPredictive Value of TestsUnited KingdomHealth Care CostsAustraliaRisk AssessmentHydroxymethylglutaryl-CoA Reductase InhibitorsCost-Effectiveness AnalysisJournal ArticleResearch Support, Non-U.S. Gov't

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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(a) International Taskforce (ITF) initiative. 2025-08-19. Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.. https://doi.org/10.1016/j.atherosclerosis.2025.120447

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