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J Cardiovasc Comput Tomogr · Jan 2020
Comparative StudyLong-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome.
- Alexander Goehler, Thomas Mayrhofer, Amit Pursnani, Maros Ferencik, Heidi S Lumish, Cordula Barth, Júlia Karády, Benjamin Chow, Quynh A Truong, James E Udelson, Jerome L Fleg, John T Nagurney, G Scott Gazelle, and Udo Hoffmann.
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology, Boston, MA, USA; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
- J Cardiovasc Comput Tomogr. 2020 Jan 1; 14 (1): 44-54.
BackgroundRandomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime.MethodsMarkov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model.ResultsEstimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10-1.17; 10-year: 5.06% vs. 5.21-5.36%; respectively).ConclusionCoronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.Copyright © 2020 Society of Cardiovascular Computed Tomography. All rights reserved.
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