{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T03:27:59Z","timestamp":1779247679714,"version":"3.51.4"},"reference-count":76,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Center of Cardiovascular Research","award":["FKZ 81Z0710102"],"award-info":[{"award-number":["FKZ 81Z0710102"]}]},{"name":"MORGAM","award":["Biomed BMH4-CT98-3183"],"award-info":[{"award-number":["Biomed BMH4-CT98-3183"]}]},{"name":"GenomEUtwin","award":["FP5, QLG2-CT-2002-01254"],"award-info":[{"award-number":["FP5, QLG2-CT-2002-01254"]}]},{"name":"ENGAGE","award":["FP7, HEALTH-F4-2007-201413"],"award-info":[{"award-number":["FP7, HEALTH-F4-2007-201413"]}]},{"name":"CHANCES","award":["FP7, HEALTH-F3-2010-242244"],"award-info":[{"award-number":["FP7, HEALTH-F3-2010-242244"]}]},{"name":"BiomarCaRE","award":["FP7, HEALTH-F2-2011-278913"],"award-info":[{"award-number":["FP7, HEALTH-F2-2011-278913"]}]},{"name":"euCanSHare","award":["Horizon 2020, No. 825903"],"award-info":[{"award-number":["Horizon 2020, No. 825903"]}]},{"name":"AFFECT-EU","award":["Horizon 2020, 847770"],"award-info":[{"award-number":["Horizon 2020, 847770"]}]},{"name":"Medical Research Foundation","award":["G0601463, No. 80983"],"award-info":[{"award-number":["G0601463, No. 80983"]}]},{"DOI":"10.13039\/501100013295","name":"Helmholtz Zentrum M\u00fcnchen","doi-asserted-by":"publisher","award":["German Research Center for Environmental Health (KORA study)"],"award-info":[{"award-number":["German Research Center for Environmental Health (KORA study)"]}],"id":[{"id":"10.13039\/501100013295","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University Hospital Augsburg"},{"DOI":"10.13039\/501100005633","name":"Finnish Foundation for Cardiovascular Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005633","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Juho Vainio Foundation"},{"name":"Swedish Heart and Lung Foundation"},{"name":"County Council of V\u00e4sterbotten"},{"DOI":"10.13039\/100014386","name":"Abbott Diagnostics","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014386","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014386","name":"Abbott Diagnostics","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014386","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Risk stratification scores such as the European Systematic COronary Risk Evaluation (SCORE) are used to guide individuals on cardiovascular disease (CVD) prevention. Adding high-sensitivity troponin I (hsTnI) to such risk scores has the potential to improve accuracy of CVD prediction. We investigated how applying hsTnI in addition to SCORE may impact management, outcome, and cost-effectiveness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Characteristics of 72,190 apparently healthy individuals from the Biomarker for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project were included into a discrete-event simulation comparing two strategies for assessing CVD risk. The standard strategy reflecting current practice employed SCORE (SCORE); the alternative strategy involved adding hsTnI information for further stratifying SCORE risk categories (S-SCORE). Individuals were followed over ten years from baseline examination to CVD event, death or end of follow-up. The model tracked the occurrence of events and calculated direct costs of screening, prevention, and treatment from a European health system perspective. Cost-effectiveness was expressed as incremental cost-effectiveness ratio (ICER) in \u20ac per quality-adjusted life year (QALYs) gained during 10 years of follow-up. Outputs were validated against observed rates, and results were tested in deterministic and probabilistic sensitivity analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>S-SCORE yielded a change in management for 10.0% of individuals, and a reduction in CVD events (4.85% vs. 5.38%, p&lt;0.001) and mortality (6.80% vs. 7.04%, p&lt;0.001). S-SCORE led to 23 (95%CI: 20\u201326) additional event-free years and 7 (95%CI: 5\u20139) additional QALYs per 1,000 subjects screened, and resulted in a relative risk reduction for CVD of 9.9% (95%CI: 7.3\u201313.5%) with a number needed to screen to prevent one event of 183 (95%CI: 172 to 203). S-SCORE increased costs per subject by 187\u20ac (95%CI: 177 \u20ac to 196 \u20ac), leading to an ICER of 27,440\u20ac\/QALY gained. Sensitivity analysis was performed with eligibility for treatment being the most sensitive.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Adding a person\u2019s hsTnI value to SCORE can impact clinical decision making and eventually improves QALYs and is cost-effective compared to CVD prevention strategies using SCORE alone. Stratifying SCORE risk classes for hsTnI would likely offer cost-effective alternatives, particularly when targeting higher risk groups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0307468","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T17:25:10Z","timestamp":1721409910000},"page":"e0307468","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cost-effectiveness of applying high-sensitivity troponin I to a score for cardiovascular risk prediction in asymptomatic population"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6606-1020","authenticated-orcid":true,"given":"Paul","family":"J\u00fclicher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6850-7735","authenticated-orcid":true,"given":"Nataliya","family":"Makarova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Ojeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Giusepi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Peters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Thorand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giancarlo","family":"Cesana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9453-2830","authenticated-orcid":true,"given":"Torben","family":"J\u00f8rgensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0994-0184","authenticated-orcid":true,"given":"Allan","family":"Linneberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7563-5324","authenticated-orcid":true,"given":"Veikko","family":"Salomaa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Licia","family":"Iacoviello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4569-1186","authenticated-orcid":true,"given":"Simona","family":"Costanzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"S\u00f6derberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Kee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Giampaoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Palmieri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Donfrancesco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2165-1411","authenticated-orcid":true,"given":"Kari","family":"Kuulasmaa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-3516","authenticated-orcid":true,"given":"Tarja","family":"Tuovinen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicity","family":"Lamrock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Conrads-Frank","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Brambilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"pone.0307468.ref001","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ijcard.2016.09.026","article-title":"The changing face of cardiovascular disease 2000\u20132012: An analysis of the world health organisation global health estimates data.","volume":"224","author":"CJ McAloon","year":"2016","journal-title":"Int J Cardiol"},{"issue":"45","key":"pone.0307468.ref002","doi-asserted-by":"crossref","first-page":"4752","DOI":"10.1093\/eurheartj\/ehad583","article-title":"Economic burden of cardiovascular diseases in the European Union: a population-based cost study","volume":"44","author":"R Luengo-Fernandez","year":"2023","journal-title":"Eur Heart J"},{"issue":"11","key":"pone.0307468.ref003","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S0195-668X(03)00114-3","article-title":"Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project","volume":"24","author":"RM Conroy","year":"2003","journal-title":"Eur Heart J"},{"issue":"1","key":"pone.0307468.ref004","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.gheart.2013.01.001","article-title":"Cardiovascular disease risk assessment: insights from Framingham","volume":"8","author":"RB D\u2019Agostino","year":"2013","journal-title":"Glob Heart"},{"key":"pone.0307468.ref005","author":"World Health Organization","year":"2007","journal-title":"Prevention of cardiovascular disease: guidelines for assessment and management of total cardiovascular risk"},{"key":"pone.0307468.ref006","volume-title":"Clinical Guideline (CG181).","author":"National Clinical Guideline Centre","year":"2014"},{"issue":"29","key":"pone.0307468.ref007","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","article-title":"2016 European Guidelines on cardiovascular disease prevention in clinical practice","volume":"37","author":"MF Piepoli","year":"2016","journal-title":"Eur Heart J"},{"issue":"18","key":"pone.0307468.ref008","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1161\/CIRCULATIONAHA.116.021407","article-title":"Recent update to the US cholesterol treatment guidelines: A comparison with international guidelines","volume":"133","author":"M Nayor","year":"2016","journal-title":"Circulation"},{"issue":"21","key":"pone.0307468.ref009","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1136\/heartjnl-2013-303698","article-title":"The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?","volume":"99","author":"TP van Staa","year":"2013","journal-title":"Heart"},{"key":"pone.0307468.ref010","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ijcard.2016.11.048","article-title":"Comparison of cardiovascular risk assessment tools and their guidelines in evaluation of 10-year CVD risk and preventive recommendations: A population based study.","volume":"228","author":"N Motamed","year":"2017","journal-title":"Int J Cardiol"},{"key":"pone.0307468.ref011","doi-asserted-by":"crossref","first-page":"e3318","DOI":"10.1136\/bmj.e3318","article-title":"Comparisons of established risk prediction models for cardiovascular disease: systematic review","volume":"344","author":"GC Siontis","year":"2012","journal-title":"BMJ"},{"key":"pone.0307468.ref012","doi-asserted-by":"crossref","first-page":"i2416","DOI":"10.1136\/bmj.i2416","article-title":"Prediction models for cardiovascular disease risk in the general population: systematic review","volume":"353","author":"JA Damen","year":"2016","journal-title":"BMJ"},{"issue":"4","key":"pone.0307468.ref013","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1093\/eurpub\/ckx216","article-title":"Current and future cardiovascular disease risk assessment in the European Union: an international comparative study.","volume":"28","author":"TJ Mossakowska","year":"2018","journal-title":"Eur J Public Health"},{"issue":"41","key":"pone.0307468.ref014","doi-asserted-by":"crossref","first-page":"4050","DOI":"10.1093\/eurheartj\/ehaa083","article-title":"High-sensitivity cardiac troponin assays for cardiovascular risk stratification in the general population","volume":"41","author":"D Farmakis","year":"2020","journal-title":"Eur Heart J"},{"key":"pone.0307468.ref015","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ypmed.2017.01.005","article-title":"Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence.","volume":"99","author":"JT Lee","year":"2017","journal-title":"Prev Med"},{"issue":"4","key":"pone.0307468.ref016","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1373\/clinchem.2014.234369","article-title":"Impact of sex on the prognostic value of high-sensitivity cardiac troponin I in the general population: the HUNT study","volume":"61","author":"T Omland","year":"2015","journal-title":"Clin Chem"},{"key":"pone.0307468.ref017","first-page":"1","article-title":"High-sensitivity cardiac troponin I and risk of cardiovascular disease in an Australian population-based cohort","volume":"0","author":"K Zhu","year":"2017","journal-title":"Heart"},{"issue":"5","key":"pone.0307468.ref018","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/eurheartj\/eht406","article-title":"High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort","volume":"35","author":"T Zeller","year":"2014","journal-title":"Eur Heart J"},{"key":"pone.0307468.ref019","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.amjcard.2018.01.004","article-title":"Relative prognostic value of cardiac troponin I and c-reactive protein in the general population (from the Nord-Trondelag Health [HUNT] study).","volume":"121","author":"FD Sigurdardottir","year":"2018","journal-title":"Am J Cardiol"},{"issue":"4","key":"pone.0307468.ref020","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1373\/clinchem.2015.250811","article-title":"High-Sensitivity Cardiac Troponin I Is a Strong Predictor of Cardiovascular Events and Mortality in the AGES-Reykjavik Community-Based Cohort of Older Individuals","volume":"62","author":"I Thorsteinsdottir","year":"2016","journal-title":"Clin Chem"},{"issue":"25","key":"pone.0307468.ref021","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1016\/j.jacc.2016.10.020","article-title":"High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease","volume":"68","author":"I Ford","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"30","key":"pone.0307468.ref022","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1093\/eurheartj\/ehw172","article-title":"Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium","volume":"37","author":"S Blankenberg","year":"2016","journal-title":"Eur Heart J"},{"key":"pone.0307468.ref023","doi-asserted-by":"crossref","article-title":"Statistical methods for the assessment of prognostic biomarkers (Part I): Discrimination","author":"G Tripepi","DOI":"10.1093\/ndt\/gfq018"},{"key":"pone.0307468.ref024","doi-asserted-by":"crossref","first-page":"122","DOI":"10.7326\/M13-1522","article-title":"Net Reclassification Improvement: Computation, Interpretation, and Controversies","volume":"160","author":"MJ Leening","year":"2014","journal-title":"Ann Intern Med"},{"key":"pone.0307468.ref025","doi-asserted-by":"crossref","first-page":"e686","DOI":"10.1136\/bmj.e686","article-title":"Assessing the value of diagnostic tests: a framework for designing and evaluating trials","volume":"344","author":"L Ferrante di Ruffano","year":"2012","journal-title":"BMJ"},{"issue":"1","key":"pone.0307468.ref026","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12874-016-0287-z","article-title":"Test-treatment RCTs are susceptible to bias: a review of the methodological quality of randomized trials that evaluate diagnostic tests.","volume":"17","author":"L Ferrante di Ruffano","year":"2017","journal-title":"BMC Med Res Methodol"},{"issue":"3","key":"pone.0307468.ref027","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2217\/fca.14.26","article-title":"Assessing the value of cardiac biomarkers: going beyond diagnostic accuracy?","volume":"10","author":"Amy Durtschi","year":"2014","journal-title":"Future Cardiol."},{"issue":"3","key":"pone.0307468.ref028","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s10198-003-0205-2","article-title":"When should decision-analytic modeling be used in the economic evaluation of health care?","volume":"4","author":"U. Siebert","year":"2003","journal-title":"Eur J Health Econ"},{"issue":"17","key":"pone.0307468.ref029","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1161\/CIRCULATIONAHA.109.192278","article-title":"Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association","volume":"119","author":"MA Hlatky","year":"2009","journal-title":"Circulation"},{"issue":"10","key":"pone.0307468.ref030","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/s10654-014-9952-x","article-title":"BiomarCaRE: rationale and design of the European BiomarCaRE project including 300,000 participants from 13 European countries","volume":"29","author":"T Zeller","year":"2014","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"pone.0307468.ref031","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1093\/ije\/dyh327","article-title":"MORGAM (an international pooling of cardiovascular cohorts).","volume":"34","author":"A Evans","year":"2005","journal-title":"Int J Epidemiol"},{"issue":"5","key":"pone.0307468.ref032","doi-asserted-by":"crossref","first-page":"485","DOI":"10.2217\/cer.15.38","article-title":"Systematic overview of cost\u2013effectiveness thresholds in ten countries across four continents.","volume":"4","author":"R Schwarzer","year":"2015","journal-title":"J Comp Eff Res"},{"issue":"57","key":"pone.0307468.ref033","first-page":"1","article-title":"The dynamics of mortality in follow-up time after an acute myocardial infarction, lower extremity arterial disease and ischemic stroke","volume":"10","author":"I Vaartjes","year":"2010","journal-title":"BMC Cardiovasc Disord"},{"key":"pone.0307468.ref034","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD009217.pub2","article-title":"Statins for the primary prevention of cardiovascular disease.","author":"F Taylor","year":"2013","journal-title":"Cochrane Database Syst Rev."},{"key":"pone.0307468.ref035","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12913-015-0772-9","article-title":"Acute and chronic impact of cardiovascular events on health state utilities.","volume":"15","author":"LS Matza","year":"2015","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0307468.ref036","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1161\/CIRCOUTCOMES.114.001240","article-title":"Quantifying the utility of taking pills for cardiovascular prevention.","volume":"8","author":"R Hutchins","year":"2015","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"7","key":"pone.0307468.ref037","doi-asserted-by":"crossref","first-page":"e66454","DOI":"10.1371\/journal.pone.0066454","article-title":"A standardized vascular disease health check in europe: a cost-effectiveness analysis.","volume":"8","author":"CA Schuetz","year":"2013","journal-title":"PloS one"},{"issue":"2","key":"pone.0307468.ref038","first-page":"1","article-title":"The use of statins in primary prevention.","volume":"2","author":"I Rosian","year":"2006","journal-title":"GMS Health Technology Assessment"},{"issue":"1","key":"pone.0307468.ref039","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13561-015-0063-5","article-title":"Costs of treating cardiovascular events in Germany: a systematic literature review.","volume":"5","author":"T Schmid","year":"2015","journal-title":"Health Econ Rev"},{"issue":"4","key":"pone.0307468.ref040","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s10389-005-0112-3","article-title":"Cost of atherothrombotic diseases\u2014myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease\u2014in","volume":"13","author":"B Br\u00fcggenj\u00fcrgen","year":"2005","journal-title":"Germany. J Public Health"},{"key":"pone.0307468.ref041","author":"European Network for Health Technology Assessment","year":"2015","journal-title":"Methods for health economic evaluations-A guideline based on current practices in Europe"},{"issue":"1 Suppl","key":"pone.0307468.ref042","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1002\/hec.1329","article-title":"The hospital costs of care for stroke in nine European countries","volume":"17","author":"D Epstein","year":"2008","journal-title":"Health Econ"},{"issue":"1 Suppl","key":"pone.0307468.ref043","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1002\/hec.1322","article-title":"Variations in hospitalisation costs for acute myocardial infarction\u2014a comparison across Europe","volume":"17","author":"O. Tiemann","year":"2008","journal-title":"Health Econ."},{"key":"pone.0307468.ref044","volume-title":"A language and environment for statistical computing.","author":"R Core Team","year":"2019"},{"issue":"6","key":"pone.0307468.ref045","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jval.2012.04.012","article-title":"Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-7.","volume":"15","author":"DM Eddy","year":"2012","journal-title":"Value Health"},{"issue":"8","key":"pone.0307468.ref046","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1007\/s10198-015-0753-2","article-title":"Modeling the costs and long-term health benefits of screening the general population for risks of cardiovascular disease: a review of methods used in the literature.","volume":"17","author":"D Epstein","year":"2016","journal-title":"Eur J Health Econ"},{"issue":"6","key":"pone.0307468.ref047","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jval.2012.06.012","article-title":"Modeling good research practices\u2014overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1.","volume":"15","author":"JJ Caro","year":"2012","journal-title":"Value Health."},{"issue":"6","key":"pone.0307468.ref048","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.jval.2012.06.014","article-title":"State-transition modeling: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-3.","volume":"15","author":"U Siebert","year":"2012","journal-title":"Value Health"},{"issue":"2","key":"pone.0307468.ref049","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jval.2013.02.010","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.","volume":"16","author":"D Husereau","year":"2013","journal-title":"Value Health."},{"issue":"4","key":"pone.0307468.ref050","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1080\/00015385.2017.1335052","article-title":"The systematic coronary risk evaluation (SCORE) for the prevention of cardiovascular diseases. Does evidence exist for its effectiveness? A systematic review","volume":"72","author":"T Tomasik","year":"2017","journal-title":"Acta Cardiol"},{"issue":"3","key":"pone.0307468.ref051","doi-asserted-by":"crossref","first-page":"e013650","DOI":"10.1136\/bmjopen-2016-013650","article-title":"Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews","volume":"7","author":"DR Collins","year":"2017","journal-title":"BMJ open"},{"issue":"1","key":"pone.0307468.ref052","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12916-019-1340-7","article-title":"Performance of the Framingham risk models and pooled cohort equations for predicting 10-year risk of cardiovascular disease: a systematic review and meta-analysis.","volume":"17","author":"JA Damen","year":"2019","journal-title":"BMC Med."},{"issue":"1","key":"pone.0307468.ref053","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12872-018-0990-2","article-title":"Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: an overview of systematic reviews","volume":"19","author":"K Studzi\u0144ski","year":"2019","journal-title":"BMC Cardiovasc Disord"},{"key":"pone.0307468.ref054","volume-title":"What is the effectiveness of systematic population-level screening programmes for reducing the burden of cardiovascular diseases?","author":"C Eriksen","year":"2021"},{"issue":"389","key":"pone.0307468.ref055","article-title":"Improving the cost-effectiveness of cardiovascular disease prevention in Australia: a modelling study.","volume":"12","author":"LJ Cobiac","year":"2012","journal-title":"BMC Public Health."},{"issue":"2","key":"pone.0307468.ref056","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1001\/jama.2015.6822","article-title":"Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease","volume":"314","author":"A Pandya","year":"2015","journal-title":"JAMA"},{"issue":"3","key":"pone.0307468.ref057","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.ijcard.2014.08.134","article-title":"Is it cost-effective to use a test to decide which individuals with an intermediate cardiovascular disease risk would benefit from statin treatment?","volume":"176","author":"LT Burgers","year":"2014","journal-title":"Int J Cardiol."},{"issue":"7","key":"pone.0307468.ref058","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jacc.2010.07.059","article-title":"The cost-effectiveness of C-reactive protein testing and rosuvastatin treatment for patients with normal cholesterol levels","volume":"57","author":"NK Choudhry","year":"2011","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0307468.ref059","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1093\/ehjqcco\/qcab005","article-title":"Estimating the cost-effectiveness of screening a general population for cardiovascular risk with high-sensitivity troponin-I","volume":"8","author":"P Julicher","year":"2022","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"issue":"9","key":"pone.0307468.ref060","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/eurheartj\/eht189","article-title":"SCORE performance in Central and Eastern Europe and former Soviet Union: MONICA and HAPIEE results","volume":"35","author":"O Vikhireva","year":"2014","journal-title":"Eur Heart J"},{"issue":"3","key":"pone.0307468.ref061","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s12471-016-0927-2","article-title":"The Dutch SCORE-based risk charts seriously underestimate the risk of cardiovascular disease","volume":"25","author":"HT Jorstad","year":"2017","journal-title":"Neth Heart J"},{"issue":"24","key":"pone.0307468.ref062","doi-asserted-by":"crossref","first-page":"2754","DOI":"10.1161\/CIRCULATIONAHA.118.038529","article-title":"Cardiac Troponin T and Troponin I in the General Population","volume":"139","author":"P Welsh","year":"2019","journal-title":"Circulation"},{"issue":"4","key":"pone.0307468.ref063","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/clinchem\/hvaa023","article-title":"Cardiac Troponin I and T Are Associated with Left Ventricular Function and Structure: Data from the Akershus Cardiac Examination 1950 Study.","volume":"66","author":"MN Lyngbakken","year":"2020","journal-title":"Clin Chem"},{"key":"pone.0307468.ref064","doi-asserted-by":"crossref","first-page":"1054959","DOI":"10.3389\/fcvm.2022.1054959","article-title":"High sensitivity troponins: A potential biomarkers of cardiovascular risk for primary prevention.","volume":"9","author":"L Leite","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"pone.0307468.ref065","first-page":"201","article-title":"Translating Clinical Research into Clinical Practice: Impact of Using Prediction rules to make decisions Ann Intern Med.","volume":"144","author":"BM Reilly","year":"2006"},{"key":"pone.0307468.ref066","year":"2019","journal-title":"National Health Service. NHS Health Check"},{"issue":"5","key":"pone.0307468.ref067","doi-asserted-by":"crossref","first-page":"e1002573","DOI":"10.1371\/journal.pmed.1002573","article-title":"Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK.","volume":"15","author":"C Kypridemos","year":"2018","journal-title":"PLoS Med"},{"key":"pone.0307468.ref068","article-title":"European Cardiovascular Disease Statistics 2017","author":"E Wilkins","year":"2017","journal-title":"Brussels: European Heart Network"},{"issue":"6","key":"pone.0307468.ref069","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1080\/14737167.2016.1259571","article-title":"Productivity losses associated with cardiovascular disease: a systematic review.","volume":"16","author":"AL Gordois","year":"2016","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"pone.0307468.ref070","volume-title":"The economic cost of cardiovascular disease from 2014\u20132020 in six European economies.","author":"Centre for Economics and Business Research (CEBR).","year":"2014"},{"issue":"4","key":"pone.0307468.ref071","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1136\/jech.2004.024349","article-title":"Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women","volume":"59","author":"P Jousilahti","year":"2005","journal-title":"Journal of epidemiology and community health"},{"issue":"25","key":"pone.0307468.ref072","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1093\/eurheartj\/ehab309","article-title":"SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe.","volume":"42","author":"SCORE2 working group and ESC Cardiovascular risk collaboration","year":"2021","journal-title":"Eur Heart J"},{"key":"pone.0307468.ref073","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ypmed.2017.12.027","article-title":"The effect of multifactorial lifestyle interventions on cardiovascular risk factors: a systematic review and meta-analysis of trials conducted in the general population and high risk groups.","volume":"109","author":"LG Sisti","year":"2018","journal-title":"Prev Med"},{"issue":"6","key":"pone.0307468.ref074","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.jval.2014.06.010","article-title":"Dynamic medication adherence modeling in primary prevention of cardiovascular disease: a Markov microsimulation methods application.","volume":"17","author":"JF Slejko","year":"2014","journal-title":"Value Health"},{"issue":"22","key":"pone.0307468.ref075","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1093\/eurheartj\/ehs210","article-title":"Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project","volume":"33","author":"D De Smedt","year":"2012","journal-title":"Eur Heart J"},{"issue":"1","key":"pone.0307468.ref076","doi-asserted-by":"crossref","first-page":"e0209314","DOI":"10.1371\/journal.pone.0209314","article-title":"Interpretation of CVD risk predictions in clinical practice: Mission impossible?","volume":"14","author":"GR Lagerweij","year":"2019","journal-title":"PloS one."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0307468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T17:26:25Z","timestamp":1721409985000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0307468"}},"subtitle":[],"editor":[{"given":"Eliseo A.","family":"Eugenin","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,7,19]]},"references-count":76,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0307468","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,19]]}}}