Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients

Abstract

Objectives The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation. Methods A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs.

The Cost Effectiveness of Coronary CT Angiography and the Effective Utilization of CT-Fractional Flow Reserve in the Diagnosis of Coronary Artery Disease

“…The utilization of CCTA has a high negative predictive value for CAD and has been shown to reduce hospital admission, length of hospital stay, and time to diagnosis, while also safely excluding acute coronary syndrome and preventing unnecessary CAG in acute chest pain patients ( Table 1 ) [ 23 , 27 , 28 , 29 ]. Although the efficacy of CCTA is established, its long-term utility as a cost-effective test is still under consideration due to the lack of long-term cost-effectiveness studies and concerns regarding increased upfront costs as well as radiation exposure and risk of nephrotoxicity [ 21 , 22 ].…”

“…A major question facing healthcare economic policy today is defining the role of CCTA in diagnosing CAD, especially in the light of national efforts to pursue more conservative diagnostic initiatives where “less is more” [ 19 , 20 , 21 ]. Conflicting evidence exists as to whether CCTA is indeed beneficial to patients; however, this may depend upon the specific indication, patient setting, suspected pretest probability, and the actual severity of CAD, among other factors [ 22 ]. Some randomized comparative effectiveness trials have demonstrated that early CCTA in emergency department (ED) triage for acute chest pain patients with suspected acute coronary syndrome (ACS) was associated with significantly decreased hospital admissions and reduced length of hospital stay compared to non-invasive methods [ 10 , 19 ].…”

Clinical Applications of CT Myocardial Perfusion Imaging

“…In 2020, the Society of Cardiovascular Computed Tomography published an expert consensus on myocardial computed tomography perfusion imaging [28], providing a consensus document that can be used as a resource for clinical implementation, resource allocation, and future investigations. As for CTP cost-effectiveness analysis, Kim et al [29] performed a study to determine the cost-effectiveness of stress CTP, CCTA, and the combination of both in suspected obstructive CAD or in-stent restenosis (ISR) in patients with previous coronary stent implantation. The cost-effectiveness was assessed based on a cost-effectiveness threshold of $100000 per quality-adjusted life years.…”