{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T21:59:57Z","timestamp":1785535197722,"version":"3.56.0"},"reference-count":72,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Coronary artery calcium scoring (\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">CACS<\/jats:styled-content>\n                      ) by computed tomography could enhance risk assessment and decision making for preventive medication in patients with diabetes. We performed a microsimulation study to compare costs and health outcomes of guideline\u2010based periodic cardiovascular risk assessment with and without\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">CACS<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We modeled various US guideline\u2010based preventive approaches based on periodically assessed 10\u2010year risk by pooled cohort equations with and without CACS. We predicted cumulative costs and quality\u2010adjusted life years (QALYs) until age 100\u2009years from the US health care sector perspective in MESA (Multi\u2010Ethnic Study of Atherosclerosis) participants aged 45 to 84\u2009years with diabetes (n=853), who were weighted to represent the US general patient population. Probabilistic and deterministic sensitivity analyses were performed to address uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Initiating high\u2010intensity statins regardless of risk and low\u2010dose aspirin if 10\u2010year risk \u226510% led to the largest QALY gains with incremental cost\u2010effectiveness ratios of $35\u2009000 to $40\u2009000\/QALY. When omitting such universal approaches, allocating high\u2010intensity statins and low\u2010dose aspirin if CACS \u2265100 led to incremental cost\u2010effectiveness ratios around $50\u2009000\/QALY. Ranking of strategies by cost\u2010effectiveness was generally robust against parameter uncertainty. The incremental cost\u2010effectiveness ratio of the CACS \u2265100 strategy fell below $50\u2009000\/QALY if the fee of CACS fell below $75 or when statin continuation was assumed to significantly improve with nonzero CAC scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Broadening the use of high\u2010intensity statins and low\u2010dose aspirin in patients aged 45 to 84\u2009years with diabetes can be considered cost\u2010effective. If broad\u2010scale use of intensive preventive treatment is either not feasible or not desired, then CACS may be cost\u2010effective in refining preventive treatment decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.041543","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T11:17:26Z","timestamp":1756466246000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Cost\u2010Effectiveness of Coronary Artery Calcium Scoring for Cardiovascular Disease Prevention in Diabetes: An Analysis From\u00a0MESA"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2754-545X","authenticated-orcid":false,"given":"Bart S.","family":"Ferket","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-2798","authenticated-orcid":false,"given":"M. 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