International Journal of Technology Assessment in Health Care

ASSESSMENTS

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

Petra Schnell-Indersta1, Ruth Schwarzera2, Alexander Göhlera3, Norma Grandia4, Kristin Grabeina5, Björn Stollenwerka6, Jennifer Mannea7, Volker Klaussa8, Uwe Sieberta9 and Jürgen Wasema10

a1 University for Health Sciences, Medical Informatics and Technology and University of Duisburg-Essen

a2 University for Health Sciences, Medical Informatics and Technology

a3 University for Health Sciences, Medical Informatics and Technology and Massachusetts General Hospital, Harvard Medical School

a4 University for Health Sciences, Medical Informatics and Technology

a5 University of Duisburg–Essen

a6 Helmholtz Zentrum München and University for Health Sciences, Medical Informatics and Technology

a7 Harvard School of Public Health

a8 University Hospital of Munich

a9 University for Health Sciences, Medical Informatics and Technology and Harvard School of Public Health and Massachusetts General Hospital, Harvard Medical School

a10 University of Duisburg–Essen

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.

Footnotes

This health technology assessment report was commissioned and funded by DAHTA@DIMDI, an agency of the Federal Ministry of Health in Germany.