title: Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany.
abstract: BACKGROUND
  Recent studies have demonstrated a superior diagnostic accuracy of cardiovascular magnetic resonance (CMR) for the detection of coronary artery disease (CAD). We aimed to determine the comparative cost-effectiveness of CMR versus single-photon emission computed tomography (SPECT).
  
  
  METHODS
  Based on Bayes' theorem, a mathematical model was developed to compare the cost-effectiveness and utility of CMR with SPECT in patients with suspected CAD. Invasive coronary angiography served as the standard of reference. Effectiveness was defined as the accurate detection of CAD, and utility as the number of quality-adjusted life-years (QALYs) gained. Model input parameters were derived from the literature, and the cost analysis was conducted from a German health care payer's perspective. Extensive sensitivity analyses were performed.
  
  
  RESULTS
  Reimbursement fees represented only a minor fraction of the total costs incurred by a diagnostic strategy. Increases in the prevalence of CAD were generally associated with improved cost-effectiveness and decreased costs per utility unit (ΔQALY). By comparison, CMR was consistently more cost-effective than SPECT, and showed lower costs per QALY gained. Given a CAD prevalence of 0.50, CMR was associated with total costs of €6,120 for one patient correctly diagnosed as having CAD and with €2,246 per ΔQALY gained versus €7,065 and €2,931 for SPECT, respectively. Above a threshold value of CAD prevalence of 0.60, proceeding directly to invasive angiography was the most cost-effective approach.
  
  
  CONCLUSIONS
  In patients with low to intermediate CAD probabilities, CMR is more cost-effective than SPECT. Moreover, lower costs per utility unit indicate a superior clinical utility of CMR.
authors.affiliation: Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Boldt
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Klaus
authors.initials: K
authors.lastname: Bonaventura
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.forename: Martin
authors.initials: M
authors.lastname: Stula
authors.forename: Alexander
authors.initials: A
authors.lastname: Huppertz
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.forename: Marc
authors.initials: M
authors.lastname: Dorenkamp
mesh_terms: D001499:Bayes Theorem; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics*