Economic Evaluations of Intravascular Imaging Guidance for Percutaneous Coronary Interventions: A Scoping Review

Intravascular imaging (IVI), including intravascular ultrasound and optical coherence tomography, has been associated with improved outcomes when used with angiography-guided percutaneous coronary intervention (PCI). Adoption in the United States and Europe has been limited by factors such as operator familiarity with the technology, device cost, and additional procedure time, although use is increasing. In the context of value-based care and constrained health care budgets, understanding whether the long-term clinical benefits of IVI justify its higher upfront procedural costs is essential. To evaluate the economic implications of IVI, a scoping review was performed to synthesize literature on the upfront costs and longer-term cost-effectiveness, with the aim of identifying drivers of cost-effectiveness and highlighting patient populations for whom IVI may yield greater economic benefit. Twenty-five studies published between January 2006 and October 2024 were included, with costs converted to 2023 US dollars. Across studies assessing costs alone, IVI-guided PCI was consistently associated with increased provider costs, typically 10% to 30% higher than angiography-guided PCI. However, among studies evaluating both costs and clinical outcomes, IVI was most often found to be cost effective or economically dominant over longer time horizons. Subgroup analyses suggested IVI is particularly cost effective in patients at a higher risk of adverse events, including those with complex lesions, ST-elevation myocardial infarction, diabetes, reduced ejection fraction, or chronic kidney disease. Time horizon and the assumed duration of IVI benefit were key drivers of cost-effectiveness. Overall, these findings suggest IVI may deliver long-term economic value despite higher initial procedural costs.