Coronary computed tomography as a cost-effective test strategy for coronary artery disease assessment - a systematic review.
Cardiovascular imaging imparts a huge burden on healthcare spending. Coronary CT angiography (CCTA) may provide a cost effective means of diagnosing coronary artery disease (CAD) and reducing downstream cost of testing. We performed a systematic search of literature for randomized controlled trials or prospective or retrospective non-randomized comparative studies or case series, decision analytic models and technology reports in which some or all of the patients underwent CCTA and looking at the cost effectiveness, comparative effectiveness and downstream test utilization associated with the use of CCTA. We found 42 articles matching our criteria. CCTA either as first line or as a layering test may represent a cost effective strategy for initial evaluation of patients with CAD prevalence of 10%-50% in both near-term and long-term diagnostic periods. For CAD prevalence ≥70%, ICA as initial test may represent cost effective strategy for diagnosis of stable chest pain. CCTA may represent cost-effective strategy when performed as a layering test to equivocal initial stress imaging before performing ICA. Use of CCTA is cost- and time-effective strategy for evaluation of low risk (<30% CAD prevalence) acute chest pain patients in emergency department and can be used for safe exclusion of acute coronary syndrome (ACS). Use of coronary calcium score as an initial test may require further evidence to be deemed cost-effective strategy. CCTA may represent a cost effective and may be associated with less downstream testing for diagnosis of stable chest pain patients in low to intermediate risk patients whereas for low risk acute chest pain patients, use of CCTA is associated with expedited patient management, less cost and safe exclusion of ACS.
Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY, USA. Electronic address: izeb82@gmail.com.
Irfan
I
Zeb
Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY, USA.
Naeem
N
Abbas
Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
Khurram
K
Nasir
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Matthew J
MJ
Budoff
D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000191:economics; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000191:economics / Q000453:epidemiology
CCTA; Cost effectiveness; Downstream testing