Testing
Lp(a) testing for primary prevention is cost-saving across every high-income country modelled, multinational microsimulation finds (Atherosclerosis 2025)
Original title: Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis
This study built and validated a multi-state microsimulation Markov model, based on 10,000 UK Biobank participants aged 40-69 without cardiovascular disease, to evaluate the cost-effectiveness of Lp(a) testing in primary prevention patients not already flagged as high-risk by age, diabetes status or SCORE-2. Those found to have Lp(a) at or above 105 nmol/L (50 mg/dL) were treated as high risk (statin plus blood pressure lowering initiated). Among 10,000 individuals, testing changed treatment for 1,807, yielding 217 and 255 quality-adjusted life years gained in Australia and the UK respectively, with incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving); from a societal perspective, testing saved $85 per person in Australia and £263 in the UK. A cost-adaptation analysis found Lp(a) testing was cost-saving across every country modelled, spanning multiple European countries, Canada and the USA. This health-economic evidence, led by a broad international author group including patient advocacy representation, strengthens the case for universal Lp(a) testing in primary prevention on economic as well as clinical grounds.
Original abstract
Background And Aims: Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives.
Methods: We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level ≥105 nmol/L (50 mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA.
Results: Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and £263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis.
Conclusions: Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.