Clinical Outcomes and Cost-Effectiveness of Coronary Computed Tomography Angiography in the Evaluation of Patients With Chest Pain

Ladapo, Joseph A.; Jaffer, Farouc A.; Hoffmann, Udo; Thomson, Carey C.; Bamberg, Fabian; Dec, William G.; Cutler, David M.; Weinstein, Milton C.; Gazelle, G. Scott

doi:10.1016/j.jacc.2009.10.012

Cited by 83 publications

(55 citation statements)

References 70 publications

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“…Several other studies have also concluded that little differences in health outcomes across diagnostic strategies exist [25][26][27]. Furthermore, it was concluded that coronary CT angiography can be a cost-saving technique [26][27][28] that can help to avoid unnecessary invasive angiograms [27], although these results were found in studies evaluating the cost-effectiveness of 64-slice CT which has lower accuracy estimates than NGCCT.…”

Section: Scenario Analysesmentioning

confidence: 99%

Cost-effectiveness analysis of new generation coronary CT scanners for difficult-to-image patients

Burgers

Redekop

et al. 2016

Eur J Health Econ

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Aims New generation dual-source coronary CT (NGCCT) scanners with more than 64 slices were evaluated for patients with (known) or suspected of coronary artery disease (CAD) who are difficult to image: obese, coronary calcium score [ 400, arrhythmias, previous revascularization, heart rate [ 65 beats per minute, and intolerance of betablocker. A cost-effectiveness analysis of NGCCT compared with invasive coronary angiography (ICA) was performed for these difficult-to-image patients for England and Wales. Methods and results Five models (diagnostic decision model, four Markov models for CAD progression, stroke, radiation and general population) were integrated to estimate the cost-effectiveness of NGCCT for both suspected and known CAD populations. The lifetime costs and effects from the National Health Service perspective were estimated for three strategies: (1) patients diagnosed using ICA, (2) using NGCCT, and (3) patients diagnosed using a combination of NGCCT and, if positive, followed by ICA. In the suspected population, the strategy where patients only undergo a NGCCT is a cost-effective option at accepted cost-effectiveness thresholds. The strategy of using NGCCT in combination with ICA is the most favourable strategy for patients with known CAD. The most influential factors behind these results are the percentage of patients being misclassified (a function of both diagnostic accuracy and the prior likelihood), the complication rates of the procedures, and the cost price of a NGCCT scan. Conclusion The use of NGCCT might be considered costeffective in both populations since it is cost-saving compared to ICA and generates similar effects.

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Section: Scenario Analysesmentioning

confidence: 99%

Cost-effectiveness analysis of new generation coronary CT scanners for difficult-to-image patients

Burgers

Redekop

et al. 2016

Eur J Health Econ

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“…33 When stress MPI was replaced with coronary CTA, at a coronary CTA cost of $420 and sensitivity and specificity of 92% and 79%, respectively, GES yielded health plan savings, with PMPM savings of $0.29 at a 50% GES capture rate. 8,18,37,38 At 100% capture rate, PMPM savings increased to $0.57.…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…The model was implemented in Microsoft Excel 2011 (Microsoft Corporation, Redmond, WA); the study team previously developed decision analysis models using this software to perform economic evaluations of health care interventions. [18][19][20] All costs were assessed from a commercial payer's perspective in 2012 US dollars. One-way sensitivity analyses were conducted on all model parameters by varying each parameter across its range and assessing the impact on results.…”

Section: Overview and Model Structurementioning

confidence: 99%

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Economic Utility of a Blood-Based Genomic Test for the Assessment of Patients with Symptoms Suggestive of Obstructive Coronary Artery Disease

Hochheiser

Juusola²,

Monane³

et al. 2014

Population Health Management

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Approximately 3 million patients with symptoms suggestive of obstructive coronary artery disease (CAD) present to primary care offices in the United States annually, resulting in approximately $6.7 billion in cardiac workup costs. Despite wide application of existing diagnostic technologies, yield of obstructive CAD at invasive coronary angiography (ICA) is low. This study used a decision analysis model to assess the economic utility of a novel gene expression score (GES) for the diagnosis of obstructive CAD. Within a representative commercial health plan's adult membership, current practice for obstructive CAD diagnosis (usual care) was compared to a strategy that incorporates the GES test (GES-directed care). The model projected the number of diagnostic tests and procedures performed, the number of patients receiving medical therapy, type I and type II errors for each strategy of obstructive CAD diagnosis, and the associated costs over a 1-year time horizon. Results demonstrate that GES-directed care to exclude the diagnosis of obstructive CAD prior to myocardial perfusion imaging may yield savings to health plans relative to usual care by reducing utilization of noninvasive and invasive cardiac imaging procedures and increasing diagnostic yield at ICA. At a 50% capture rate of eligible patients in GES-directed care, it is projected that a commercial health plan will realize savings of $0.77 per member per month; savings increase proportionally to the GES capture rate. These findings illustrate the potential value of this new blood-based, molecular diagnostic test for health plans and patients in an age of greater emphasis on personalized medicine. (Population Health Management 2014;17:287-296)

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“…A recent decision analytic model examined a comparison of the cost-effectiveness of CCTA to MPS in stable chest pain patients, specifically modeling out the costs of incidental findings and nondiagnostic examinations [19]. The authors of this analysis determined that health outcomes of individuals undergoing CCTA or MPS were similar, but with small gains in quality-adjusted life years (QALY) conferred by undergoing CCTA.…”

Section: Resource Utilization Costs and Clinical Outcomesmentioning

confidence: 99%

Economic Considerations for Coronary CT Angiography

Min

Sharma

Nicolo

2010

Curr Cardiovasc Imaging Rep

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In recent years, coronary CT angiography (CCTA) has emerged has a noninvasive anatomic imaging modality that demonstrates high diagnostic performance to detect and exclude high-grade coronary artery stenosis. Proponents of CCTA have advocated its use as an effective alternative to functional stress imaging, while critics have maintained that the benefits of CCTA use remain unproven and may promote unnecessary "layering" of imaging studies on top of conventional stress testing. In this review, we consider the clinical and economic data related to CCTA to date, and suggest future studies that may clarify the role of CCTA in daily clinical evaluation of patients with suspected or known coronary artery disease.

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Clinical Outcomes and Cost-Effectiveness of Coronary Computed Tomography Angiography in the Evaluation of Patients With Chest Pain

Abstract: CCTA is comparable to other diagnostic studies and might hold good clinical value, but large randomized controlled trials are needed to guide policy.

Cited by 83 publications

References 70 publications

Cost-effectiveness analysis of new generation coronary CT scanners for difficult-to-image patients

Cost-effectiveness analysis of new generation coronary CT scanners for difficult-to-image patients

Economic Utility of a Blood-Based Genomic Test for the Assessment of Patients with Symptoms Suggestive of Obstructive Coronary Artery Disease

Economic Considerations for Coronary CT Angiography

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