Multiple biomarkers for the prediction of first major cardiovascular events and death: considerable costs and limited benefits.

Cardiovascular disorders are responsible for high morbidity and mortality and pose a substantial economic burden at the individual, institutional, and national levels. The accurate risk stratification, appropriate and institution-specific triage to interventional vs medical strategies, and optimal pharmacologic therapy are major goals for the management of these pathologies. In addition to the conventional risk factors, there is substantial interest in the use of novel biomarkers to identify people who are at risk for the development of cardiovascular disease and who could be targeted for preventive measures.[1] A recent study in which researchers assessed the ability of 10 innovative biomarkers (C-reactive protein, B-type natriuretic peptide, N-terminal proatrial natriuretic peptide, aldosterone, renin, fibrinogen, D-dimer, plasminogen activator inhibitor type 1, homocysteine, and urinary albumin-to-creatine ratio) to predict first major cardiovascular events and death found that the addition of these biomarkers to traditional risk factors did not add much in classifying future risk for cardiovascular events in healthy individuals.[2] We assessed the potential cost-to-benefit ratio of the broad application of this panel of biomarkers in assessing the risk for cardiovascular diseases. The overall estimated cost according to the 2007 Clinical Diagnostic Laboratory Fee Schedule national median payment amount was $373.64 per panel. The application of this panel to the US population that would potentially benefit from this screening (persons 16–64 years of age), estimated to be 193.6 million persons according to the US Census Bureau,[3] would incur an estimated cost of $72.4 billion. According to the National Heart Lung and Blood Institute, the 2006 projected cost estimate for cardiovascular diseases amounted to $403 billion, which included $258 billion for direct health expenditures, $36 billion in indirect costs for morbidity, and $110 billion in indirect costs for mortality.[4] Due to increasing cost constraints and the limited usefulness in classifying risk, the estimated expense of the application of this panel does not justify preventive screening in large populations of healthy people.