Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

Abstract

We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of euro4,435 (10% likelihood) to euro1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society.

Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy

“…23,[45][46][47][48][49] The expenditure on coronary diagnostic tests is substantial, 50 and every effort should be made to decrease its economic burden on society. Whether 320-row CT can further optimize cost-effectiveness compared with previous CT approaches 51 is an important question. Moreover, a diagnostic test is only justified if it can provide incremental information that will change practice so as to favorably affect clinical outcome.…”

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

“…The results of various modeling approaches agree in their assessment that an appropriate use of cardiac CT in low-to intermediate-risk patients with ACP is associated with cost savings compared with stress testing, especially in younger men and women. [102][103][104] …”

Low-dose triple-rule-out using 320-row-detector volume MDCT – less contrast medium and lower radiation exposure

“…Nonvascular causes such as pneumonia, pericardial effusion, pneumothorax, or pericarditis can also be diagnosed by this imaging technique. Different TRO protocols for the evaluation of chest pain have been increasingly used since several studies proved their technical feasibility and cost-effectiveness [1][2][3].…”