Incorporating carotid-femoral pulse wave velocity into SCORE2(OP) risk assessment for individuals with elevated blood pressure was cost-effective, with ICERs ranging from 351 to 5,200 EUR/QALY.
Does incorporating cfPWV into SCORE2(OP) risk stratification improve cost-effectiveness of primary CVD prevention in individuals with elevated blood pressure?
Integrating cfPWV into SCORE2(OP) risk stratification is a highly cost-effective strategy for optimizing primary cardiovascular disease prevention in individuals with elevated blood pressure across multiple age groups.
Effect estimate: ICER 351 to 5,200 EUR/QALY
Objective: Arterial stiffness, a key feature of vascular ageing, independently predicts cardiovascular disease (CVD) risk. Although carotid–femoral pulse wave velocity (cfPWV) provides a reliable and simple measure of arterial stiffness, its adoption in routine practice remains limited, partly due to perceived cost implications. This study evaluated the cost-effectiveness of incorporating cfPWV into cardiovascular risk assessment for individuals with elevated blood pressure (BP) in primary prevention settings, in accordance with the 2024 ESC guidelines for the management of elevated BP and hypertension. Design and method: A hybrid decision tree–Markov model was applied to estimate lifetime health and economic outcomes of three treatment strategies for individuals with elevated BP (systolic BP of 120–139 or diastolic BP of 70–89 mm Hg): (1) no risk stratification, (2) ESC guideline–based assessment using SCORE2(OP), and (3) a combined approach using SCORE2(OP) and cfPWV. Analyses were stratified by baseline age (40, 50, 60, and 70 years). Model outcome included lifetime quality-adjusted life-years (QALYs) and healthcare costs. Results: At age 40, SCORE2(OP)-based assessment showed similar cost-effectiveness to no stratification, whereas adding cfPWV produced an incremental cost-effectiveness ratio (ICER) of 5,200 EUR/QALY (compared with SCORE2(OP) alone) (Figure A). At age 50, SCORE2(OP) versus no stratification yielded an ICER of 734 EUR/QALY, and adding cfPWV to SCORE2(OP) resulted in an ICER of 2,276 EUR/QALY (compared to SCORE2(OP) alone). From age 60 onward, SCORE2(OP)-based assessment dominated the no-stratification approach (i.e., negative ICERs), and the combined SCORE2(OP) and cfPWV strategy remained highly cost-effective, with ICERs of 1,190 EUR/QALY at age 60, and 351 EUR/QALY at age 70 (both versus SCORE2(OP) alone). Sensitivity analyses confirmed that all cfPWV-inclusive strategies remained well below the conventional 50,000 EUR willingness-to-pay (WTP) threshold, and even under a more stringent 20,000 EUR/QALY benchmark, results remained within acceptable cost-effectiveness ranges, highlighting the robustness of our findings (Figure B). Conclusions: Integrating cfPWV into ESC based SCORE2(OP) risk stratification provides a cost-effective means of optimizing primary CVD prevention in individuals with elevated blood pressure.
Spronck et al. (Fri,) conducted a other in Elevated blood pressure. Combined risk assessment using SCORE2(OP) and cfPWV vs. SCORE2(OP) alone or no risk stratification was evaluated on Lifetime quality-adjusted life-years (QALYs) and healthcare costs (ICER 351 to 5,200 EUR/QALY). Incorporating carotid-femoral pulse wave velocity into SCORE2(OP) risk assessment for individuals with elevated blood pressure was cost-effective, with ICERs ranging from 351 to 5,200 EUR/QALY.