{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T12:32:41Z","timestamp":1766493161429,"version":"3.44.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Phayao and Thailand Science Research and Innovation Fund","award":["Fundamental Fund 2025, Grant No. 5017\/2567. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."],"award-info":[{"award-number":["Fundamental Fund 2025, Grant No. 5017\/2567. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study aims to evaluate the cost-utility of Coronary Artery Calcium (CAC) screening for primary prevention in Thai patients with intermediate cardiovascular disease (CVD) risk, compared to the current practice according to the ACC\/AHA 2019 guideline recommendation without the use of a CAC score.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A hybrid model combining a decision tree and a Markov model was constructed to compare costs and QALYs from a societal perspective. The model evaluated a target population of statin-na\u00efve individuals aged 40\u201375 with intermediate CVD risk. We assessed the impact of statin initiation for primary prevention based on the ACC\/AHA 2019 guideline with CAC screening compared to without CAC screening over a 35-year time horizon. The service costs and related household expenses were based on the Thai setting. The incremental cost-effectiveness ratio (ICER) was compared against the official willingness-to-pay threshold of Thailand (160,000 THB, approximately 4,400 USD per QALY). Probabilistic and additional one-way sensitivity analyses were performed to assess the robustness of the model and evaluate how variations in key assumptions impact the results. These analyses help determine the reliability of the findings by exploring the extent to which changes in input parameters influence the overall conclusions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The CAC screening strategy required an incremental cost of 10,091 THB to gain 0.62 QALYs per person, resulting in an ICER of 16,308 THB per QALY gained. For the probabilistic sensitivity analysis, at the official Thai threshold, the probability of cost-effectiveness was 71% for CAC screening. Sensitivity analyses based on varying the effect of drug adherence, drug cost, incidence of CVD events, and the distribution of CAC scores demonstrated robust cost-effectiveness favouring CAC screening.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>CAC screening strategy is cost-effective in the Thai context, especially when the cost of screening and high-potency statins is low.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0330425","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:28:41Z","timestamp":1755797321000},"page":"e0330425","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-utility analysis of Coronary Artery Calcium screening to guide statin prescription among intermediate-risk patients in Thailand"],"prefix":"10.1371","volume":"20","author":[{"given":"Pakpoom","family":"Wongyikul","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8543-6254","authenticated-orcid":true,"given":"Phichayut","family":"Phinyo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pannipa","family":"Suwannasom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apichat","family":"Tantraworasin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1382-0660","authenticated-orcid":true,"given":"Surasak","family":"Saokaew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"issue":"10","key":"pone.0330425.ref001","article-title":"World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions","volume":"7","author":"WHO CVD Risk Chart Working Group","year":"2019","journal-title":"Lancet Glob Health"},{"issue":"10100","key":"pone.0330425.ref002","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"GBD 2016 Causes of Death Collaborators","year":"2017","journal-title":"Lancet"},{"issue":"1","key":"pone.0330425.ref003","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1186\/s12889-018-5806-x","article-title":"The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review","volume":"18","author":"A Gheorghe","year":"2018","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0330425.ref004","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1038\/s41598-023-28494-3","article-title":"Rising trends in the predicted 10-year risk of cardiovascular diseases among Royal Thai Army personnel from 2017 to 2021","volume":"13","author":"B Sakboonyarat","year":"2023","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0330425.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacasi.2021.04.007","article-title":"Epidemiological Features of Cardiovascular Disease in Asia","volume":"1","author":"D Zhao","year":"2021","journal-title":"JACC Asia"},{"volume-title":"Thailand Public Health Statistics 2019","year":"2019","author":"Bureau of Policy and Strategy, Ministry of Public Health (Thailand), Bureau of Registration Administration (Thailand), Department of Provincial Administration (Thailand), Ministry of Interior (Thailand), Ministry of Public Health (Thailand), National Statistical Office (Thailand)","key":"pone.0330425.ref006"},{"issue":"2","key":"pone.0330425.ref007","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1093\/ije\/dyq218","article-title":"Cohort profile: the electricity generating authority of Thailand study","volume":"41","author":"P Vathesatogkit","year":"2012","journal-title":"Int J Epidemiol"},{"key":"pone.0330425.ref008","unstructured":"The Royal College of Physicians of Thailand. 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