Cost-effectiveness analysis of stress cardiovascular magnetic resonance imaging for stable chest pain syndromes

Item Type:	Article
Title:	Cost-effectiveness analysis of stress cardiovascular magnetic resonance imaging for stable chest pain syndromes
Creators Name:	Ge, Y. and Pandya, A. and Steel, K. and Bingham, S. and Jerosch-Herold, M. and Chen, Y.Y. and Mikolich, J.R. and Arai, A.E. and Bandettini, W.P. and Patel, A.R. and Farzaneh-Far, A. and Heitner, J.F. and Shenoy, C. and Leung, S.W. and Gonzalez, J.A. and Shah, D.J. and Raman, S.V. and Ferrari, V.A. and Schulz-Menger, J. and Hachamovitch, R. and Stuber, M. and Simonetti, O.P. and Kwong, R.Y.
Abstract:	OBJECTIVES: The aim of this study was to compare, using results from the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, the incremental cost-effectiveness of a stress cardiovascular magnetic resonance (CMR)-first strategy against 4 other clinical strategies for patients with stable symptoms suspicious for myocardial ischemia: 1) immediate x-ray coronary angiography (XCA) with selective fractional flow reserve for all patients; 2) single-photon emission computed tomography; 3) coronary computed tomographic angiography with selective computed tomographic fractional flow reserve; and 4) no imaging. BACKGROUND: Stress CMR perfusion imaging has established excellent diagnostic utility and prognostic value in coronary artery disease (CAD), but its cost-effectiveness in current clinical practice has not been well studied in the United States. METHODS: A decision analytic model was developed to project health care costs and lifetime quality-adjusted life years (QALYs) for symptomatic patients at presentation with a 32.4% prevalence of obstructive CAD. Rates of clinical events, costs, and quality-of-life values were estimated from SPINS and other published research. The analysis was conducted from a U.S. health care system perspective, with health and cost outcomes discounted annually at 3%. RESULTS: Using hard cardiovascular events (cardiovascular death or acute myocardial infarction) as the endpoint, total costs per person were lowest for the no-imaging strategy ($16,936) and highest for the immediate XCA strategy ($20,929). Lifetime QALYs were lowest for the no-imaging strategy (12.72050) and highest for the immediate XCA strategy (12.76535). The incremental cost-effectiveness ratio for the CMR-based strategy compared with the no-imaging strategy was $52,000/QALY, whereas the incremental cost-effectiveness ratio for the immediate XCA strategy was $12 million/QALY compared with CMR. Results were sensitive to variations in model inputs for prevalence of disease, hazard rate ratio for treatment of CAD, and annual discount rate. CONCLUSIONS: Prior to invasive XCA, stress CMR can be a cost-effective gatekeeping tool in patients at risk for obstructive CAD in the United States. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891.
Keywords:	Cost-Effectiveness, Noninvasive Test, Stress Cardiac MRI, Chest Pain, Coronary Angiography, Coronary Artery Disease, Cost-Benefit Analysis, Myocardial Fractional Flow Reserve, Magnetic Resonance Imaging, Myocardial Perfusion Imaging, Predictive Value of Tests
Source:	JACC: Cardiovascular Imaging
ISSN:	1936-878X
Publisher:	Elsevier
Volume:	13
Number:	7
Page Range:	1505-1517
Date:	July 2020
Official Publication:	https://doi.org/10.1016/j.jcmg.2020.02.029
PubMed:	View item in PubMed

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