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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Cost-effectiveness of cardiovascular imaging for stable coronary heart disease
Simon Walker1, Edward Cox2, Ben Rothwell3
1Centre for Health Economics, University of York, York, UK simon.walker@york.ac.uk.
Insights
Cardiovascular magnetic resonance (CMR) is the most cost-effective strategy for managing suspected coronary heart disease (CHD), offering superior health outcomes and lower costs compared to myocardial perfusion scintigraphy (MPS) and NICE guidelines.
Area of Science:
- Cardiology
- Health Economics
- Medical Imaging
Background:
- Chest pain is a common symptom requiring accurate diagnosis of coronary heart disease (CHD).
- Current management strategies include cardiovascular magnetic resonance (CMR), myocardial perfusion scintigraphy (MPS), and UK National Institute for Health and Care Excellence (NICE) guideline-guided care.
- Assessing the cost-effectiveness of these strategies is crucial for optimal patient management.
Purpose of the Study:
- To evaluate the cost-effectiveness of CMR, MPS, and NICE guidelines for patients with suspected CHD.
- To compare health outcomes (QALYs) and costs associated with each management strategy.
- To determine the most economically viable approach for diagnosing and managing suspected coronary heart disease.
Main Methods:
- Economic evaluation using UK data from 1202 patients (Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial).
- Health outcomes measured in Quality-Adjusted Life-Years (QALYs).
- Costs analyzed in UK pound sterling (2016-2017), with results presented as incremental cost-effectiveness ratios and net health benefits across CHD likelihood subgroups.
Main Results:
- Cardiovascular magnetic resonance (CMR) yielded the highest QALY gain overall compared to NICE guidelines and MPS.
- CMR incurred comparable costs to NICE and MPS, demonstrating a dominant strategy (more effective, less costly).
- CMR showed a 93% probability of cost-effectiveness at a £15,000 per QALY threshold, with similar findings across pretest likelihood subgroups.
Conclusions:
- CMR-guided care is a cost-effective strategy for managing patients with suspected coronary heart disease (CHD).
- This cost-effectiveness extends across all pretest likelihood subgroups when compared to MPS and NICE guidelines.
- CMR offers a superior and economically advantageous approach to diagnosing and managing suspected CHD.
Objective:
To assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care.
Methods:
Using UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016-2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups.
Results:
CMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (-0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups.
Conclusions:
CMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.
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