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Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease
Paul B Jacklin1, Sally F Barrington, James C Roxburgh
1London School of Hygiene and Tropical Medicine, Health Services Research Unit, United Kingdom. paul.jacklin@lshtm.ac.uk
Insights
Positron emission tomography (PET) is a cost-effective tool for selecting patients with ischemic heart disease and poor left ventricular function for coronary artery bypass grafting, potentially improving survival and reducing costs.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Health Economics
Background:
- Coronary artery bypass grafting (CABG) for ischemic heart disease with poor left ventricular function is costly and risky.
- Hibernating myocardium may improve survival post-revascularization.
- Positron emission tomography (PET) can identify hibernating myocardium.
Purpose of the Study:
- To evaluate the cost-effectiveness of using PET to select patients for CABG.
- To compare three management strategies: universal CABG, PET-guided CABG, and medical therapy alone.
Main Methods:
- Development of an economic model comparing three strategies.
- Utilized hospital data and published literature.
- Conducted a sensitivity analysis to assess key influencing factors.
Main Results:
- PET-guided CABG was cost-effective, saving life-years and approximately £3 million in a hypothetical cohort of 1,000 patients.
- PET-guided CABG saved lives compared to medical therapy alone but incurred higher costs (incremental cost per life-year saved: £77,000).
- Hibernation prevalence and survival rates of non-revascularized patients significantly impacted cost-effectiveness.
Conclusions:
- Positron emission tomography (PET) is a potentially cost-effective method for selecting patients with poor left ventricular function for coronary artery bypass grafting (CABG).
- PET can optimize patient selection for revascularization, balancing survival benefits with economic considerations.
Background:
Revascularization of patients with ischemic heart disease and poor left ventricular function for surgical procedures is expensive and carries considerable risks, but may improve survival for patients with hibernating myocardium. Positron emission tomography can detect hibernating myocardium, and may be cost-effective if used to select patients for operation.
Methods:
An economic model was developed to compare the cost-effectiveness of three management strategies: (1) coronary artery bypass grafting for all patients; (2) using positron emission tomography to select candidates for coronary artery bypass grafting, those without hibernation remaining on medical therapy; and (3) medical therapy for all patients. The model used data from our hospital and the published literature. A sensitivity analysis was also undertaken.
Results:
Positron emission tomography was cost-effective in selecting patients for operation. In a hypothetical population of 1,000 patients, using positron emission tomography saved marginally more life-years and cost approximately Pound Sterling 3 million less. Using positron emission tomography before coronary artery bypass grafting instead of all patients receiving medical treatment saved lives but was more expensive. The incremental cost per life-year saved was Pound Sterling 77,000. The sensitivity analysis showed that the prevalence of hibernation and the survival rate of patients refused revascularization on the basis of the positron emission tomography scan were the areas most likely to influence cost-effectiveness.
Conclusions:
Positron emission tomography may be cost-effective to select patients with poor left ventricular function for coronary artery bypass grafting.