Journal of Cardiovascular Magnetic Resonance (Jan 2022)

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

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

DOI
https://doi.org/10.1186/s12968-021-00833-1
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 14

Abstract

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Abstract 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.

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