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The cost-effectiveness of cardiac computed tomography for patients with stable chest pain
A M Agus1, P McKavanagh2, L Lusk3
1Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK.
Insights
Cardiac CT is more cost-effective than exercise stress testing for stable chest pain patients. This diagnostic approach improves quality of life and offers significant value in healthcare settings.
Area of Science:
- Cardiology
- Health Economics
- Diagnostic Imaging
Background:
- Stable chest pain is a common presentation in primary care.
- Accurate diagnosis is crucial for appropriate management and improving patient outcomes.
- Current diagnostic pathways involve various imaging and functional tests.
Purpose of the Study:
- To compare the cost-effectiveness of cardiac CT versus exercise stress testing (EST).
- To evaluate the impact on health-related quality of life in patients with stable chest pain.
- To determine the optimal diagnostic strategy for chest pain assessment.
Main Methods:
- A single-centre randomized controlled trial (RCT) was conducted.
- Cost-utility analysis was performed alongside the RCT.
- Patients were randomized to cardiac CT or EST, with outcomes measured at 1 year.
Main Results:
- Cardiac CT was found to be the dominant strategy, being less costly and more effective.
- The incremental cost per Quality Adjusted Life Year (QALY) gained favored cardiac CT.
- Cardiac CT demonstrated an 83% probability of being cost-effective at a £20,000/QALY threshold.
Conclusions:
- Cardiac CT is a cost-effective alternative to EST for patients with stable chest pain.
- Cost-effectiveness varies with the pre-test probability of coronary artery disease (CAD).
- Findings suggest a potential shift in diagnostic protocols for chest pain in the UK.
Objective:
To assess the cost-effectiveness of cardiac CT compared with exercise stress testing (EST) in improving the health-related quality of life of patients with stable chest pain.
Methods:
A cost-utility analysis alongside a single-centre randomised controlled trial carried out in Northern Ireland. Patients with stable chest pain were randomised to undergo either cardiac CT assessment or EST (standard care). The main outcome measure was cost per quality adjusted life year (QALY) gained at 1 year.
Results:
Of the 500 patients recruited, 250 were randomised to cardiac CT and 250 were randomised to EST. Cardiac CT was the dominant strategy as it was both less costly (incremental total costs -£50.45; 95% CI -£672.26 to £571.36) and more effective (incremental QALYs 0.02; 95% CI -0.02 to 0.05) than EST. At a willingness-to-pay threshold of £20 000 per QALY the probability of cardiac CT being cost-effective was 83%. Subgroup analyses indicated that cardiac CT appears to be most cost-effective in patients with a likelihood of coronary artery disease (CAD) of <30%, followed by 30%-60% and then >60%.
Conclusions:
Cardiac CT is cost-effective compared with EST and cost-effectiveness was observed to vary with likelihood of CAD. This finding could have major implications for how patients with chest pain in the UK are assessed, however it would need to be validated in other healthcare systems.
Trial Registration Number:
(ISRCTN52480460); results.
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