Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems.
BACKGROUND
Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD.


METHODS
A subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings.


RESULTS
In the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA.


CONCLUSIONS
This analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.
Institute of Health Economics and Management (IEMS), University of Lausanne, Lausanne, Switzerland. Karine.Moschetti@chuv.ch
Karine
K
Moschetti
Stefano
S
Muzzarelli
Christophe
C
Pinget
Anja
A
Wagner
Günther
G
Pilz
Jean-Blaise
JB
Wasserfallen
Jeanette
J
Schulz-Menger
Detle
D
Nothnagel
Torsten
T
Dill
Herbert
H
Frank
Massimo
M
Lombardi
Oliver
O
Bruder
Heiko
H
Mahrholdt
Jürg
J
Schwitter
D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D017023:Coronary Angiography / Q000191:economics*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005060:Europe; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D017150:Public Sector / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D012042:Registries; D013222:State Medicine / Q000191:economics; D014481:United States