Journal Article

Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease

Grizzard, John D., White, James A., Selvanayagam, Joseph B., Ge, Yin, Kwong, Raymond Y., Raman, Subha V., Carr, James, Yu, Yuan-Jui, Bucciarelli-Ducci, Chiara, Ferrari, Victor A., Schwitter, Juerg, Pandya, Ankur, Sierra-Galan, Lilia M., Petersen, Steffen E., Rashedi, Nina, Merkler, Alexander E., Simonetti, Orlando P., Nagel, Eike, Kelle, Sebastian, Bakar, Rafidah Abu, Bhatia, Mona, Ntusi, Ntobeko

2022

Overview

Background Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs. Methods We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR Cost-Effectiveness Calculator) based on a larger CMR cost-effectiveness simulation model that can approximate CMR lifetime discount cost, QALY, and cost effectiveness compared to relevant comparators [such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA)] or invasive coronary angiography. Results CMR was cost-effective for evaluation of significant CAD (either health-improving and cost saving or having a cost-per-QALY or cost-per-life-year result lower than the cost-effectiveness threshold) versus its relevant comparator in 10 out of 15 studies, with 3 studies reporting uncertain cost effectiveness, and 2 studies showing CCTA was optimal. Our cost-effectiveness calculator showed that CCTA was not cost-effective in the US compared to CMR when the most recent publications on imaging performance were included in the model. Conclusions Based on current world-wide evidence in the literature, CMR usually represents a cost-effective option compared to relevant comparators to assess for significant CAD.

• Publisher: BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Angiography / Angiology / Cardiac patients / Cardiology / Cardiovascular disease / Cardiovascular magnetic resonance / Comparative analysis / Comparators / Computed tomography / Coronary Angiography / Coronary artery / Coronary artery disease / Coronary Artery Disease - diagnostic imaging / Coronary heart disease / Coronary vessels / Cost analysis / Cost benefit analysis / Cost effectiveness / CT imaging / Decision making / Economic aspects / English language / Heart diseases / Humans / Imaging / Literature reviews / Magnetic resonance / Magnetic Resonance Spectroscopy / Medical care, Cost of / Medical imaging / Medicine / Medicine & Public Health / Monte Carlo simulation / Patients / Photon emission / Predictive Value of Tests / Radiology / Regression analysis / Regression models / Sensitivity analysis / Single photon emission computed tomography / SPECT imaging / Tomography / Vein & artery diseases