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Prognostic value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein as a marker for major cardiac events in asymptomatic individuals: A health technology assessment report

Published online by Cambridge University Press:  08 January 2010

Petra Schnell-Inderst ,
Ruth Schwarzer ,
Alexander Göhler ,
Norma Grandi ,
Kristin Grabein ,
Björn Stollenwerk ,
Jennifer Manne ,
Volker Klauss ,
Uwe Siebert  and
Jürgen Wasem
Petra Schnell-Inderst
Affiliation:
University for Health Sciences, Medical Informatics and Technology and University of Duisburg-Essen
Ruth Schwarzer
Affiliation:
University for Health Sciences, Medical Informatics and Technology
Alexander Göhler
Affiliation:
University for Health Sciences, Medical Informatics and Technology and Massachusetts General Hospital, Harvard Medical School
Norma Grandi
Affiliation:
University for Health Sciences, Medical Informatics and Technology
Kristin Grabein
Affiliation:
University of Duisburg–Essen
Björn Stollenwerk
Affiliation:
Helmholtz Zentrum München and University for Health Sciences, Medical Informatics and Technology
Jennifer Manne
Affiliation:
Harvard School of Public Health
Volker Klauss
Affiliation:
University Hospital of Munich
Uwe Siebert
Affiliation:
University for Health Sciences, Medical Informatics and Technology and Harvard School of Public Health and Massachusetts General Hospital, Harvard Medical School
Jürgen Wasem
Affiliation:
University of Duisburg–Essen
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Abstract

Objectives: The aim of this study was to compare the predictive value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein (hs-CRP)-screening in addition to traditional risk factor screening in apparently healthy persons as a means of preventing coronary artery disease.

Methods and Results: The systematic review was performed according to internationally recognized methods. Seven studies on risk prediction, one clinical decision-analytic modeling study, and three decision-analytic cost-effectiveness studies were included. The adjusted relative risk of high hs-CRP-level ranged from 0.7 to 2.47 (p < .05 in four of seven studies). Adding hs-CRP to the prediction models increased the areas under the curve by 0.00 to 0.027. Based on the clinical decision analysis, both individuals with elevated hs-CRP-levels and those with hyperlipidemia have a similar gain in life expectancy following statin therapy. One high-quality economic modeling study suggests favorable incremental cost-effectiveness ratios for persons with elevated hs-CRP and higher risk. However, many model parameters were based on limited evidence.

Conclusions: Adding hs-CRP to traditional risk factors improves risk prediction, but the clinical relevance and cost-effectiveness of this improvement remain unclear.

Keywords

Coronary artery diseaseRisk predictionHigh-sensitivity C-reactive proteinSystematic reviewCost-effectivenessHealth technology assessment
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 1 , January 2010 , pp. 30 - 39
Copyright
Copyright © Cambridge University Press 2010

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