title: Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of coronary artery disease.
abstract: OBJECTIVE
  We compared cost-effectiveness and potential lifetime benefits of using dual-energy computed tomography (DECT) for myocardial perfusion assessment instead of single photon emission computed tomography (SPECT) for the workup of coronary artery disease (CAD).
  
  
  METHODS
  A decision and simulation model was developed to estimate cost and health effects of using DECT myocardial perfusion imaging instead of SPECT for identifying patients in need of invasive imaging and possible revascularization. The model was based on the performance indices of stress/rest DECT compared with stress/rest SPECT for detecting myocardial perfusion deficits in 50 patients (mean age 61±10 years) with CAD. Stress/rest perfusion and delayed enhancement cardiac MRI served as reference standard. For DECT a reimbursement of US$1700 was assumed but costs of cardiac MRI were not included in the model. All other actual healthcare costs in these patients were derived from MUSC's hospital billing system.
  
  
  RESULTS
  Compared with cardiac MRI, DECT (versus SPECT) had 90% (85%) sensitivity and 71% (58%) specificity for identifying patients with obstructive CAD. Compared with the no imaging and no treatment strategy, routine SPECT gained 13.49 quality-adjusted life-years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$3557 (in 2010) per QALY. In comparison, DECT ICER was lower (US$3.191 per QALY, p=0.0002) and an additional 0.64 QALYs was obtained (total of 14.13 QALYs) if compared with the SPECT strategy as well as the no imaging and no treatment strategy.
  
  
  CONCLUSIONS
  Using DECT as the first-line imaging test for myocardial perfusion for the workup of patients with CAD has the potential to provide gains in QALYs, while lowering costs if compared to routine myocardial perfusion SPECT.
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Mathias
authors.initials: M
authors.lastname: Meyer
authors.forename: John W
authors.initials: JW
authors.lastname: Nance
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Antonio
authors.initials: A
authors.lastname: Moscariello
authors.forename: Markus
authors.initials: M
authors.lastname: Weininger
authors.forename: Garrett W
authors.initials: GW
authors.lastname: Rowe
authors.forename: Balazs
authors.initials: B
authors.lastname: Ruzsics
authors.forename: Doo Kyoung
authors.initials: DK
authors.lastname: Kang
authors.forename: Salvatore A
authors.initials: SA
authors.lastname: Chiaramida
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000191:economics* / Q000706:statistics & numerical data; D015900:Radiography, Dual-Energy Scanned Projection / Q000191:economics* / Q000706:statistics & numerical data; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology