Implications of Coronary Artery Calcium Testing for Treatment Decisions Among Statin Candidates According to the ACC/AHA Cholesterol Management Guidelines: A Cost-Effectiveness Analysis

JACC Cardiovasc Imaging. 2017 Aug;10(8):938-952. doi: 10.1016/j.jcmg.2017.04.014.


This review evaluates the cost-effectiveness of using coronary artery calcium (CAC) to guide long-term statin therapy compared with treating all patients eligible for statins according to 2013 American College of Cardiology/American Heart Association cholesterol management guidelines for atherosclerotic cardiovascular disease. The authors used a microsimulation model to compare costs and effectiveness from a societal perspective over a lifetime horizon. Both strategies resulted in similar costs and quality-adjusted life years (QALYs). CAC resulted in increased costs (+$81) and near-equal QALY (+0.01) for an incremental cost-effectiveness ratio of $8,100/QALY compared with the treat-all strategy. For 10,000 patients, the treat-all strategy would theoretically avert 21 atherosclerotic cardiovascular disease events, but would add 47,294 person-years of statins. With CAC costs <$100, and higher cost and/or disutility associated with statin therapy, CAC strategy was favored. These findings suggest the economic value of both approaches were similar. Clinicians should account for individual preferences in context of shared decision making when choosing the most appropriate strategy to guide statin decisions.

Keywords: CAC; atherosclerosis; cholesterol; cost-effectiveness analysis; risk assessment; statins.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • American Heart Association*
  • Bayes Theorem
  • Clinical Decision-Making
  • Computer Simulation
  • Coronary Angiography / adverse effects
  • Coronary Angiography / economics*
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / drug therapy
  • Coronary Artery Disease* / economics
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / drug effects
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Drug Costs*
  • Female
  • Guideline Adherence / economics*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Middle Aged
  • Models, Economic
  • Monte Carlo Method
  • Multivariate Analysis
  • Practice Guidelines as Topic*
  • Predictive Value of Tests
  • Quality of Life
  • Quality-Adjusted Life Years
  • Time Factors
  • Treatment Outcome
  • United States
  • Vascular Calcification* / diagnostic imaging
  • Vascular Calcification* / drug therapy
  • Vascular Calcification* / economics


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors