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Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease

Pandya A 1 , Yu YJ 2 , Ge Y 3 , Nagel E 4 , Kwong RY 3 , Bakar RA 5 Show all authors , Grizzard JD 6 , Merkler AE 7 , Ntusi N 8 , Petersen SE 9 , Rashedi N 10 , Schwitter J 11 , Selvanayagam JB 12 , White JA 13 , Carr J 14 , Raman SV 15 , Simonetti OP 16 , Bucciarelli-Ducci C 17 , Sierra-Galan LM 18 , Ferrari VA 19 , Bhatia M 20 , Kelle S 21

Affiliations 

  • 1 Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA. anpandya@hsph.harvard.edu
  • 2 National Taiwan University Hospital, Taipei, Taiwan
  • 3 Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
  • 4 Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, Partner Site RheinMain, University Hospital Frankfurt/Main, Frankfurt am Main, Germany
  • 5 Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
  • 6 Department of Radiology, Virginia Commonwealth University Medical Center, Main Hospital, Richmond, VA, USA
  • 7 Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
  • 8 Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
  • 9 William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
  • 10 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
  • 11 Division of Cardiology, Cardiovascular Department, CMR Center University Hospital, Lausanne, Switzerland
  • 12 Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia
  • 13 Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
  • 14 Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
  • 15 Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
  • 16 Departments of Internal Medicine and Radiology, The Ohio State University, Columbus, OH, USA
  • 17 Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals and School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
  • 18 Cardiovascular Division, Department of Cardiology, American British Cowdray Medical Center, Mexico City, Mexico
  • 19 Cardiovascular Division and Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
  • 20 Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
  • 21 Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
J Cardiovasc Magn Reson, 2022 01 06;24(1):1.
PMID: 34986851 DOI: 10.1186/s12968-021-00833-1

Abstract

BACKGROUND: Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs.

METHODS: We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR Cost-Effectiveness Calculator) based on a larger CMR cost-effectiveness simulation model that can approximate CMR lifetime discount cost, QALY, and cost effectiveness compared to relevant comparators [such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA)] or invasive coronary angiography.

RESULTS: CMR was cost-effective for evaluation of significant CAD (either health-improving and cost saving or having a cost-per-QALY or cost-per-life-year result lower than the cost-effectiveness threshold) versus its relevant comparator in 10 out of 15 studies, with 3 studies reporting uncertain cost effectiveness, and 2 studies showing CCTA was optimal. Our cost-effectiveness calculator showed that CCTA was not cost-effective in the US compared to CMR when the most recent publications on imaging performance were included in the model.

CONCLUSIONS: Based on current world-wide evidence in the literature, CMR usually represents a cost-effective option compared to relevant comparators to assess for significant CAD.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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