The cost-effectiveness of diagnostic cardiac imaging for stable coronary artery disease

Area of Science:

• Cardiology
• Health Economics
• Medical Imaging

Background:

• Early diagnosis of stable coronary artery disease (CAD) is essential for reducing patient morbidity, mortality, and healthcare expenditures.
• Non-invasive diagnostic cardiac imaging plays a critical role in the diagnostic pathway for CAD.
• Health-economic evaluations are increasingly important for guiding clinical decisions.

Purpose of the Study:

• To critically appraise health-economic literature on non-invasive diagnostic cardiac imaging for stable CAD.
• To summarize economic evaluation approaches and procedural risks associated with cardiac imaging.
• To inform cardiologists on utilizing economic analyses and identify cost-effective diagnostic strategies for stable CAD.

Main Methods:

• Systematic review and critical appraisal of existing health-economic studies.
• Analysis of cost-effectiveness data for various non-invasive cardiac imaging modalities.
• Evaluation of economic evidence in relation to patient pre-test probability of CAD.

Main Results:

• Current economic evidence is insufficient to definitively guide the selection of imaging modalities or strategies for individual patients.
• Computed tomography coronary angiography (CTCA) appears cost-effective for excluding CAD before invasive procedures in patients with low-to-intermediate pre-test probability.
• Stress imaging modalities demonstrate cost-effectiveness at varying pre-test probabilities for stable CAD diagnosis.

Conclusions:

• Economic analysis can aid cardiologists in decision-making for stable CAD diagnosis.
• CTCA is a promising cost-effective strategy for ruling out CAD in specific patient groups.
• Further research is needed to strengthen economic evaluations and provide clearer guidance on optimal diagnostic pathways for stable CAD.