Health economic analysis of polygenic risk score use in primary prevention of coronary artery disease - A system dynamics model

Stephen T Vernon; Stuart Brentnall; Danielle J Currie; Cindy Peng; Michael P Gray; Giordano Botta; Deo Mujwara; Stephen J Nicholls; Stuart M Grieve; Julie Redfern; Clara Chow; Jean-Frederic Levesque; Peter J Meikle; Garry Jennings; Zanfina Ademi; Andrew Wilson; Gemma A Figtree

doi:10.1016/j.ajpc.2024.100672

Health economic analysis of polygenic risk score use in primary prevention of coronary artery disease - A system dynamics model

Am J Prev Cardiol. 2024 May 18:18:100672. doi: 10.1016/j.ajpc.2024.100672. eCollection 2024 Jun.

Authors

Stephen T Vernon^{1

2

3}, Stuart Brentnall⁴, Danielle J Currie⁴, Cindy Peng⁴, Michael P Gray^{1

3}, Giordano Botta⁵, Deo Mujwara⁵, Stephen J Nicholls⁶, Stuart M Grieve^{7

8}, Julie Redfern⁹, Clara Chow¹⁰, Jean-Frederic Levesque^{11

12}, Peter J Meikle^{13

14}, Garry Jennings¹⁵, Zanfina Ademi^{16

17}, Andrew Wilson¹⁸, Gemma A Figtree^{1

2

3}

Affiliations

¹ Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, Australia.
² Department of Cardiology, Royal North Shore Hospital, Australia.
³ Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia.
⁴ Decision Analytics, The SAX Institute, Sydney, Australia.
⁵ Allelica Inc, New York, United States.
⁶ Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia.
⁷ Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
⁸ Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁹ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Westmead Applied Research Centre (C.K.C.), University of Sydney, Australia.
¹¹ NSW Health, Sydney, NSW, Australia.
¹² Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia.
¹³ Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
¹⁴ Monash University, Melbourne, VIC, 3800, Australia.
¹⁵ University of Sydney, Sydney, NSW, Australia.
¹⁶ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
¹⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹⁸ Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia.

Abstract

Background: Primary prevention programs utilising traditional risk scores fail to identify all individuals who suffer acute cardiovascular events. We aimed to model the impact and cost effectiveness of incorporating a Polygenic risk scores (PRS) into the cardiovascular disease CVD primary prevention program in Australia, using a whole-of-system model.

Methods: System dynamics models, encompassing acute and chronic CVD care in the Australian healthcare setting, assessing the cost-effectiveness of incorporating a CAD-PRS in the primary prevention setting. The time horizon was 10-years.

Results: Pragmatically incorporating a CAD-PRS in the Australian primary prevention setting in middle-aged individuals already attending a Heart Health Check (HHC) who are determined to be at low or moderate risk based on the 5-year Framingham risk score (FRS), with conservative assumptions regarding uptake of PRS, could have prevented 2, 052 deaths over 10-years, and resulted in 24, 085 QALYs gained at a cost of $19, 945 per QALY with a net benefit of $724 million. If all Australians overs the age of 35 years old had their FRS and PRS performed, and acted upon, 12, 374 deaths and 60, 284 acute coronary events would be prevented, with 183, 682 QALYs gained at a cost of $18, 531 per QALY, with a net benefit of $5, 780 million.

Conclusions: Incorporating a CAD-PRS in a contemporary primary prevention setting in Australia would result in substantial health and societal benefits and is cost-effective. The broader the uptake of CAD-PRS in the primary prevention setting in middle-aged Australians, the greater the impact and the more cost-effective the strategy.

Keywords: Cardiovascular disease; Coronary artery disease; Health economics; Polygenic risk score.