Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease.
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.
Dewey
Marc
M
Department of Radiology, Charité, Medical School, Humboldt University, Charitéplatz 1, 10117, Berlin, Germany. marc.dewey@charite.de
Hamm
Bernd
B
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics; D017023:Coronary Angiography / Q000191:economics*; D003327:Coronary Disease / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D025401:Echocardiography, Stress / Q000191:economics; D004562:Electrocardiography / Q000191:economics; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics*