Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography

Darlington, Meryl; Guéret, Pascal; Laissy, Jean-Pierre; Pierucci, A. Filipovic; Maoulida, Hassani; Quelen, Céline; Niarra, Ralph; Châtellier, Gilles; Durand‐Zaleski, Isabelle

doi:10.1007/s10198-014-0616-2

Cited by 16 publications

(9 citation statements)

References 26 publications

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“…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: 61%

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: 61%

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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“…It is considered to be the gold standard for the diagnosis of CHD (Wu et al, 2019). However, conventional coronary angiography is an invasive examination method, and the cost of computed tomography coronary angiography is relatively high (Darlington et al, 2015). In rural areas of China, due to the limited medical level, this CHD diagnosis method has not been widely used.…”

Section: Discussionmentioning

confidence: 99%

Prediction of coronary heart disease in rural Chinese adults: a cross sectional study

Wang

et al. 2021

PeerJ

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Background Coronary heart disease (CHD) is a common cardiovascular disease with high morbidity and mortality in China. The CHD risk prediction model has a great value in early prevention and diagnosis. Methods In this study, CHD risk prediction models among rural residents in Xinxiang County were constructed using Random Forest (RF), Support Vector Machine (SVM), and the least absolute shrinkage and selection operator (LASSO) regression algorithms with identified 16 influencing factors. Results Results demonstrated that the CHD model using the RF classifier performed best both on the training set and test set, with the highest area under the curve (AUC = 1 and 0.9711), accuracy (one and 0.9389), sensitivity (one and 0.8725), specificity (one and 0.9771), precision (one and 0.9563), F1-score (one and 0.9125), and Matthews correlation coefficient (MCC = one and 0.8678), followed by the SVM (AUC = 0.9860 and 0.9589) and the LASSO classifier (AUC = 0.9733 and 0.9587). Besides, the RF model also had an increase in the net reclassification index (NRI) and integrated discrimination improvement (IDI) values, and achieved a greater net benefit in the decision curve analysis (DCA) compared with the SVM and LASSO models. Conclusion The CHD risk prediction model constructed by the RF algorithm in this study is conducive to the early diagnosis of CHD in rural residents of Xinxiang County, Henan Province.

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“…In patients with acute coronary syndrome and a low to intermediate likelihood, CTA is a safe and effacious alternative to the CCA [ 22 ], showing the potential for additional diagnostic testing [ 23 ]. Beside the diagnostic accuracy, CT may improve the cost-effectiveness in comparison to CCA in patients with an intermediate risk [ 23 , 24 ]. Thus, CTA may represent an alternative first-step-diagnostic tool, if the necessity of coronary stenting is not likely [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents—Intraindividual Comparison

et al. 2015

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ObjectivesTo evaluate how well patients with coronary stents accept combined coronary computed tomography angiography (CTA) and myocardial CT perfusion (CTP) compared with conventional coronary angiography (CCA).BackgroundWhile combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined.MethodsA total of 90 patients with coronary stents prospectively underwent CTA/CTP (both with contrast agent, CTP with adenosine) and CCA as part of the CARS-320 study. In this group, an intraindividual comparison of patient acceptance of CTA, CTP, and CCA was performed.ResultsCTP was experienced to be significantly more painful than CTA (p<0.001) and was associated with a higher frequency of dyspnea (p<0.001). Comparison of CTA/CTP with CCA revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377). Concern before CTA/CTP and CCA and overall satisfaction were likewise not significantly different (p = 0.097 and p = 0.123, respectively). Nevertheless, about two thirds (n = 60, 68%) preferred CTA/CTP to CCA (p<0.001). Moreover, patients felt less helpless during CTA/CTP than during CCA (p = 0.026). Lack of invasiveness and absence of pain were the most frequently mentioned advantages of CTA/CTP over CCA in our patient population.ConclusionsCCA and combined CTA/CTP are equally well accepted by patients; however, more patients prefer CTA/CTP. CTP was associated with more intense pain than CTA and more frequently caused dyspnea than CTA alone.Trial RegistrationClinicalTrials.gov NCT00967876

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Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography

Cited by 16 publications

References 26 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

Prediction of coronary heart disease in rural Chinese adults: a cross sectional study

Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents—Intraindividual Comparison

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