TY - JOUR
T1 - Cost-effectiveness in diagnosis of stable angina patients
T2 - a decision-analytical modelling approach
AU - Nazir, Muhummad
AU - Rodriguez Guadarrama, Yael
AU - Duarte de Oliveira Rua, Tiago Rua
AU - Bui, Khanh Ha
AU - Buylova Gola, Anna
AU - Chiribiri, Amedeo
AU - McCrone, Paul
AU - Plein, Sven
AU - Pennington, Mark
N1 - Funding Information:
The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy?s & St Thomas? NHS Foundation Trust in partnership with King?s College London and King?s College Hospital NHS Foundation Trust and by the NIHR MedTech Co-operative for Cardiovascular Disease at Guy?s and St Thomas? NHS Foundation Trust. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0416-20008). The economic analysis was developed at the Wellcome/EPSRC Centre for Medical Engineering (WT 203148/Z/16/Z) with support from King?s Health Economics. MSN was fun?ded by a Clinical Lectureship funded by the NIHR under grant code CL-2019-17-001. SP was funded by the British Heart Foundation under grant number CH/16/2/32089.
Funding Information:
Funding The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust and by the NIHR MedTech Co-operative for Cardiovascular Disease at Guy’s and St Thomas’ NHS Foundation Trust. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0416-20008). The economic analysis was developed at the Wellcome/EPSRC Centre for Medical Engineering (WT 203148/Z/16/Z) with support from King’s Health Economics. MSN was funded by a Clinical Lectureship funded by the NIHR under grant code CL-2019-17-001. SP was funded by the British Heart Foundation under grant number CH/16/2/32089.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2022/4/4
Y1 - 2022/4/4
N2 - OBJECTIVE: Given recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the reference standard.METHODS: A probabilistic decision-analytical model was developed which modelled a cohort of patients with stable angina. We investigated 17 diagnostic strategies between standalone and combination of different imaging tests to establish a correct diagnosis of CAD, using no testing as the baseline reference. These tests included CT coronary angiography (CTCA), stress echocardiography, CT-based FFR, single-photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), positron emission tomography, ICA, and ICA with FFR. Incremental cost-effectiveness ratios were calculated as the additional cost per correct diagnosis.RESULTS: SPECT followed by CTCA and ICA-FFR is the most cost-effective strategy between a cost-effectiveness threshold (CET) value of £1000-£3000 per correct diagnosis. CMR followed by CTCA and ICA-FFR is cost-effective within a CET range of £3000-£17 000 per correct diagnosis. CMR and ICA-FFR is cost-effective within a CET range of £17 000-£24 000. ICA-FFR as first line is the most-cost effective if the CET value exceeds the £24 000 per correct diagnosis. Sensitivity analysis showed that direct ICA-FFR may be cost-effective in patients with a high pre-test probability of CAD.CONCLUSION: First-line testing with functional imaging is cost-effective at low to intermediate value of correct diagnosis in patients with low to intermediate risk of CAD. ICA is not cost effective although ICA-FFR may be at higher CET.
AB - OBJECTIVE: Given recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the reference standard.METHODS: A probabilistic decision-analytical model was developed which modelled a cohort of patients with stable angina. We investigated 17 diagnostic strategies between standalone and combination of different imaging tests to establish a correct diagnosis of CAD, using no testing as the baseline reference. These tests included CT coronary angiography (CTCA), stress echocardiography, CT-based FFR, single-photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), positron emission tomography, ICA, and ICA with FFR. Incremental cost-effectiveness ratios were calculated as the additional cost per correct diagnosis.RESULTS: SPECT followed by CTCA and ICA-FFR is the most cost-effective strategy between a cost-effectiveness threshold (CET) value of £1000-£3000 per correct diagnosis. CMR followed by CTCA and ICA-FFR is cost-effective within a CET range of £3000-£17 000 per correct diagnosis. CMR and ICA-FFR is cost-effective within a CET range of £17 000-£24 000. ICA-FFR as first line is the most-cost effective if the CET value exceeds the £24 000 per correct diagnosis. Sensitivity analysis showed that direct ICA-FFR may be cost-effective in patients with a high pre-test probability of CAD.CONCLUSION: First-line testing with functional imaging is cost-effective at low to intermediate value of correct diagnosis in patients with low to intermediate risk of CAD. ICA is not cost effective although ICA-FFR may be at higher CET.
KW - Angina, Stable/diagnostic imaging
KW - Coronary Angiography/methods
KW - Coronary Artery Disease/diagnostic imaging
KW - Cost-Benefit Analysis
KW - Fractional Flow Reserve, Myocardial
KW - Humans
UR - http://www.scopus.com/inward/record.url?scp=85128395640&partnerID=8YFLogxK
U2 - 10.1136/openhrt-2021-001700
DO - 10.1136/openhrt-2021-001700
M3 - Article
C2 - 35379740
SN - 2053-3624
VL - 9
JO - Open Heart
JF - Open Heart
IS - 1
M1 - e001700
ER -
