Costs and clinical outcomes for non-invasive versus invasive diagnostic approaches to patients with suspected in-stent restenosis.
This study compared costs and clinical outcomes of invasive versus non-invasive diagnostic evaluations for patients with suspected in-stent restenosis (ISR) after percutaneous coronary intervention. We developed a decision model to compare 2 year diagnosis-related costs for patients who presented with suspected ISR and were evaluated by: (1) invasive coronary angiography (ICA); (2) non-invasive stress testing strategy of myocardial perfusion imaging (MPI) with referral to ICA based on MPI; (3) coronary CT angiography-based testing strategy with referral to ICA based on CCTA. Costs were modeled from the payer's perspective using 2014 Medicare rates. 56 % of patients underwent follow-up diagnostic testing over 2 years. Compared to ICA, MPI (98.6 %) and CCTA (98.1 %) exhibited lower rates of correct diagnoses. Non-invasive strategies were associated with reduced referrals to ICA and costs compared to an ICA-based strategy, with diagnostic costs lower for CCTA than MPI. Overall 2-year costs were highest for ICA for both metallic as well as BVS stents ($1656 and $1656, respectively) when compared to MPI ($1444 and $1411) and CCTA. CCTA costs differed based upon stent size and type, and were highest for metallic stents >3.0 mm followed by metallic stents <3.0 mm, BVS < 3.0 mm and BVS > 3.0 mm ($1466 vs. $1242 vs. $855 vs. $490, respectively). MPI for suspected ISR results in lower costs and rates of complications than invasive strategies using ICA while maintaining high diagnostic performance. Depending upon stent size and type, CCTA results in lower costs than MPI.
Department of Radiology, Weill Cornell Medical College, New York, NY, USA. runone123@gmail.com.|Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, 413 E. 69th Street, Suite 108, New York, 10021, NY, USA. runone123@gmail.com.
James K
JK
Min
Abbott Vascular, Santa Clara, CA, USA.
James T
JT
Hasegawa
Abbott Vascular, Santa Clara, CA, USA.
Susanne F
SF
Machacz
Xcenda, Palm Harbor, FL, USA.
Ken
K
O'Day
D017023:Coronary Angiography / Q000191:economics; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000191:economics; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000191:economics*; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000191:economics; D062645:Percutaneous Coronary Intervention; D015607:Stents / Q000191:economics*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome
Computed tomography; Cost efficiency; Revascularization; Stents