Journal Article

Cost-effectiveness of cardiovascular imaging for stable coronary heart disease

Stocken, Deborah, Cox, Edward, Mangion, Kenneth, Dall’Armellina, Erica, Everett, Colin, Sculpher, Mark, McCann, Gerry P, Bucciarelli-Ducci, Chiara, Bijsterveld, Petra, Berry, Colin, Greenwood, John P, Foley, James Robert John, Prasad, Abhiram, Plein, Sven, Walker, Simon, Rothwell, Ben

2021

Overview

ObjectiveTo assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care.MethodsUsing UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016–2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups.ResultsCMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (−0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups.ConclusionsCMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Angina pectoris / Angioplasty / cardiac imaging and diagnostics / cardiac magnetic resonance (CMR) imaging / Cardiovascular disease / Cardiovascular diseases / Coronary Artery Disease / Coronary Disease - diagnostic imaging / Coronary vessels / Cost analysis / Cost-Benefit Analysis / Diagnostic tests / Female / health care economics / Heart surgery / Humans / Magnetic resonance imaging / Magnetic Resonance Imaging, Cine - economics / Male / Medical imaging / Middle Aged / Monte Carlo simulation / Myocardial Perfusion Imaging - economics / Opportunity costs / Pain / Patients / Practice Guidelines as Topic / Quality-Adjusted Life Years / Questionnaires / Scintigraphy / Tariffs / United Kingdom