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Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients
S H Kim1, J Rübenthaler1, D Nörenberg2
1Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Insights
Stress myocardial CT perfusion (CTP) is a cost-effective diagnostic tool for detecting coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with prior stenting, offering added value over coronary CT angiography (CTA).
Area of Science:
- Cardiovascular Imaging
- Health Economics
- Medical Decision Making
Background:
- Assessing obstructive coronary artery disease (CAD) and in-stent restenosis (ISR) is crucial in patients with previous coronary stent implantation.
- Coronary CT angiography (CTA) and CT perfusion (CTP) are diagnostic modalities used for evaluating CAD.
- The cost-effectiveness of these imaging strategies requires thorough evaluation.
Purpose of the Study:
- To determine the cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and their combination.
- To evaluate these strategies in patients with suspected obstructive CAD or ISR after coronary stent implantation.
Main Methods:
- A Markov simulation decision model was employed to estimate lifetime costs and quality-adjusted life years (QALYs).
- Model inputs were derived from published literature.
- Probabilistic and deterministic sensitivity analyses were conducted to assess model uncertainty and robustness.
Main Results:
- In the base-case, CT perfusion (CTP) demonstrated higher effectiveness (6.93 QALYs) at a lower cost ($46,758.83) compared to CTA (6.84 QALYs, $47,013.87) and CTA + CTP ($47,455.63, 6.85 QALYs).
- CTP was found to be cost-effective in the majority of probabilistic sensitivity analysis iterations.
- Deterministic sensitivity analysis confirmed the robustness of CTP's cost-effectiveness across a broad range of parameters.
Conclusions:
- CTP is a cost-effective imaging strategy for detecting obstructive CAD or ISR in patients with previous coronary stenting.
- CTP offers added diagnostic value and should be considered a feasible approach in clinical practice.
- The findings support the integration of CTP into the diagnostic pathway for this patient population.
Objectives:
The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation.
Methods:
A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs. Cost-effectiveness was assessed based on a cost-effectiveness threshold of $100,000 per QALY.
Results:
In the base-case scenario with willingness to pay of $100,000 per QALY, CTA resulted in total costs of $47,013.87 and an expected effectiveness of 6.84 QALYs, whereas CTP resulted in total costs of $46,758.83 with 6.93 QALYs. CTA + CTP reached costs of $47,455.63 with 6.85 QALYs. Therefore, strategies CTA and CTA + CTP were dominated by CTP in the base-case scenario. Deterministic sensitivity analysis demonstrated robustness of the model to variations of diagnostic efficacy parameters and costs in a broad range. CTP was cost-effective in the majority of iterations in the probabilistic sensitivity analysis as compared with CTA.
Conclusions:
CTP is cost-effective for the detection of obstructive CAD or ISR in patients with previous stenting and therefore should be considered a feasible approach in daily clinical practice.
Key Points:
• CTP provides added diagnostic value in patients with previous coronary stents. • CTP is a cost-effective method for the detection of obstructive CAD or ISR in patients with previous stenting.
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