title: Cost-effectiveness of 64-slice CT angiography compared to conventional coronary angiography based on a coverage with evidence development study in Ontario.
abstract: Conventional coronary angiography (CCA) is the standard diagnostic for coronary artery disease (CAD), but multi-detector computed tomography coronary angiography (CTCA) is a non-invasive alternative.
  
  
  METHODS
  A multi-center coverage with evidence development study was undertaken and combined with an economic model to estimate the cost-effectiveness of CTCA followed by CCA vs CCA alone. Alternative assumptions were tested in patient scenario and sensitivity analyses.
  
  
  RESULTS
  CCA was found to dominate CTCA, however, CTCA was relatively more cost-effective in females, in advancing age, in patients with lower pre-test probabilities of CAD, the higher the sensitivity of CTCA and the lower the probability of undergoing a confirmatory CCA following a positive CTCA.
  
  
  CONCLUSIONS
  RESULTS were very sensitive to alternative patient populations and modeling assumptions. Careful consideration of patient characteristics, procedures to improve the diagnostic yield of CTCA and selective use of CCA following CTCA will impact whether CTCA is cost-effective or dominates CCA.
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.forename: Gord
authors.initials: G
authors.lastname: Blackhouse
authors.forename: James M
authors.initials: JM
authors.lastname: Bowen
authors.forename: Daria
authors.initials: D
authors.lastname: O'Reilly
authors.forename: Simone
authors.initials: S
authors.lastname: Sutherland
authors.forename: Robert
authors.initials: R
authors.lastname: Hopkins
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chow
authors.forename: Michael
authors.initials: M
authors.lastname: Freeman
authors.forename: Yves
authors.initials: Y
authors.lastname: Provost
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
authors.forename: Eric
authors.initials: E
authors.lastname: Cohen
authors.forename: Dan
authors.initials: D
authors.lastname: Marcuzzi
authors.forename: Robert
authors.initials: R
authors.lastname: Iwanochko
authors.forename: Alan
authors.initials: A
authors.lastname: Moody
authors.forename: Narinder
authors.initials: N
authors.lastname: Paul
authors.forename: John D
authors.initials: JD
authors.lastname: Parker
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000191:economics / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D061330:Multidetector Computed Tomography / Q000191:economics / Q000379:methods*; D009864:Ontario; D011336:Probability; D012680:Sensitivity and Specificity; D012737:Sex Factors