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Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS
Karine Moschetti1, Raymond Y Kwong2, Steffen E Petersen3
1Health Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland; Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Insights
A noninvasive cardiac magnetic resonance (CMR) guided strategy significantly reduces healthcare costs compared to invasive methods like coronary angiography (CXA) with or without fractional flow reserve (FFR). This cost-effectiveness applies across all patient risk levels.
Area of Science:
- Cardiovascular Imaging
- Health Economics
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) poses a significant public health challenge.
- Stress perfusion cardiac magnetic resonance (CMR) offers high accuracy in detecting CAD.
- Despite guidelines, noninvasive testing adherence for stable CAD patients remains suboptimal.
Purpose of the Study:
- To compare the economic impact of a noninvasive CMR-guided strategy against two invasive approaches: coronary angiography (CXA) with fractional flow reserve (FFR) and CXA alone.
- To evaluate cost-effectiveness across diverse patient risk profiles for CAD diagnosis and management.
Main Methods:
- Analysis of cost data from the EuroCMR and SPINS registries, encompassing 12 global healthcare systems.
- Inclusion of costs for diagnostic tests (CMR, CXA with/without FFR), revascularizations, and 1-year follow-up complications.
- Comparison of a CMR-guided strategy (CMR+CXA) with hypothetical CXA+FFR and CXA-only invasive strategies.
Main Results:
- The CMR+CXA strategy demonstrated significant cost savings compared to the CXA+FFR strategy across all 12 healthcare systems.
- Cost savings were substantial, ranging from 31% to 52% in low- to high-risk patients.
- Even greater cost reductions were observed when comparing CMR+CXA to CXA-only, with savings between 52% and 73%.
Conclusions:
- A cardiac magnetic resonance (CMR)-guided strategy offers consistent and significant cost savings compared to invasive fractional flow reserve (FFR) guided strategies.
- The noninvasive CMR approach proves highly cost-effective across the full spectrum of patient risk for diagnosing coronary artery disease.
- Implementing CMR-guided strategies can lead to substantial economic benefits in cardiovascular healthcare systems globally.
Objectives:
The aim of this study was to compare the costs of a noninvasive cardiac magnetic resonance (CMR)-guided strategy versus 2 invasive strategies with and without fractional flow reserve (FFR).
Background:
Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion CMR has excellent accuracy to detect CAD. International guidelines recommend as a first step noninvasive testing of patients in stable condition with known or suspected CAD. However, nonadherence in routine clinical practice is high.
Methods:
In the EuroCMR (European Cardiovascular Magnetic Resonance) registry (n = 3,647, 59 centers, 18 countries) and the U.S.-based SPINS (Stress-CMR Perfusion Imaging in the United States) registry (n = 2,349, 13 centers, 11 states), costs were calculated for 12 health care systems (8 in Europe, the United States, 2 in Latin America, and 1 in Asia). Costs included diagnostic examinations (CMR and x-ray coronary angiography [CXA] with and without FFR), revascularizations, and complications during 1-year follow-up. Seven subgroup analyses covered low- to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization at the treating physician's discretion (CMR+CXA strategy). In the hypothetical invasive CXA+FFR strategy, costs were calculated for initial CXA and FFR in vessels with ≥50% stenoses, assuming the same proportion of revascularizations and complications as with the CMR+CXA strategy and FFR-positive rates as given in the published research. In the CXA-only strategy, costs included CXA and revascularizations of ≥50% stenoses.
Results:
Consistent cost savings were observed for the CMR+CXA strategy compared with the CXA+FFR strategy in all 12 health care systems, ranging from 42% ± 20% and 52% ± 15% in low-risk EuroCMR and SPINS patients with atypical chest pain, respectively, to 31% ± 16% in high-risk SPINS patients with known CAD (P < 0.0001 vs 0 in all groups). Cost savings were even higher compared with CXA only, at 63% ± 11%, 73% ± 6%, and 52% ± 9%, respectively (P < 0.0001 vs 0 in all groups).
Conclusions:
In 12 health care systems, a CMR+CXA strategy yielded consistent moderate to high cost savings compared with a hypothetical CXA+FFR strategy over the entire spectrum of risk. Cost savings were consistently high compared with CXA only for all risk groups.
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