Cost Effectiveness of Coronary Angiography and Calcium Scoring Using CT and Stress MRI for Diagnosis of Coronary Artery Disease

Overview

Journal Eur Radiol

Specialty Radiology

Date 2006 Oct 13

PMID 17031453

Citations 38

Authors

Marc Dewey

Bernd Hamm

Affiliations

Soon will be listed here.

Abstract

We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of euro4,435 (10% likelihood) to euro1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society.

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References

Balady G, Beasley J, Bricker J, Duvernoy W, Froelicher V, Mark D . ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997; 30(1):260-311. DOI: 10.1016/s0735-1097(97)00150-2. View

Nagel E, Lehmkuhl H, Bocksch W, Klein C, Vogel U, Frantz E . Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation. 1999; 99(6):763-70. DOI: 10.1161/01.cir.99.6.763. View

Wintersperger B, Nikolaou K . Basics of cardiac MDCT: techniques and contrast application. Eur Radiol. 2005; 15 Suppl 2:B2-9. DOI: 10.1007/s10406-005-0090-0. View

Patterson R, Eisner R, Horowitz S . Comparison of cost-effectiveness and utility of exercise ECG, single photon emission computed tomography, positron emission tomography, and coronary angiography for diagnosis of coronary artery disease. Circulation. 1995; 91(1):54-65. DOI: 10.1161/01.cir.91.1.54. View

Fleischmann K, Hunink M, Kuntz K, Douglas P . Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. JAMA. 1998; 280(10):913-20. DOI: 10.1001/jama.280.10.913. View

Elkin M . President's address. Issues in radiology related to the new technologies. Radiology. 1982; 143(1):1-6. DOI: 10.1148/radiology.143.1.6801726. View

Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B . Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation. 2003; 107(5):664-6. DOI: 10.1161/01.cir.0000055738.31551.a9. View

Klever-Deichert G, Hinzpeter B, Hunsche E, Lauterbach K . [Costs of coronary heart diseases over the remaining life time in coronary heart disease cases--an analysis of the current status of coronary heart disease cases in Germany from the social perspective]. Z Kardiol. 2000; 88(12):991-1000. DOI: 10.1007/s003920050381. View

Pryor D, Shaw L, McCants C, Lee K, Mark D, Harrell Jr F . Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med. 1993; 118(2):81-90. DOI: 10.7326/0003-4819-118-2-199301150-00001. View

10.

Nallamothu B, Saint S, Bielak L, Sonnad S, Peyser P, Rubenfire M . Electron-beam computed tomography in the diagnosis of coronary artery disease: a meta-analysis. Arch Intern Med. 2001; 161(6):833-8. DOI: 10.1001/archinte.161.6.833. View

11.

Patterson R, Eng C, Horowitz S, Gorlin R, Goldstein S . Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease. J Am Coll Cardiol. 1984; 4(2):278-89. DOI: 10.1016/s0735-1097(84)80214-4. View

12.

Dewey M, Borges A, Kivelitz D, Taupitz M, Wagner S, Baumann G . Coronary artery disease: new insights and their implications for radiology. Eur Radiol. 2003; 14(6):1048-54. DOI: 10.1007/s00330-003-2175-2. View

13.

Lipton M, Bogaert J, Boxt L, Reba R . Imaging of ischemic heart disease. Eur Radiol. 2002; 12(5):1061-80. DOI: 10.1007/s003300101131. View

14.

Hovels A, Heesakkers R, Adang E, Jager G, Barentsz J . Cost-analysis of staging methods for lymph nodes in patients with prostate cancer: MRI with a lymph node-specific contrast agent compared to pelvic lymph node dissection or CT. Eur Radiol. 2004; 14(9):1707-12. DOI: 10.1007/s00330-004-2374-5. View

15.

Pugliese F, Mollet N, Runza G, Van Mieghem C, Meijboom W, Malagutti P . Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol. 2005; 16(3):575-82. DOI: 10.1007/s00330-005-0041-0. View

16.

Bogaert J, Dymarkowski S . Delayed contrast-enhanced MRI: use in myocardial viability assessment and other cardiac pathology. Eur Radiol. 2005; 15 Suppl 2:B52-8. DOI: 10.1007/s10406-005-0093-x. View

17.

Sommer T, Hofer U, Omran H, Schild H . [Stress cine MRI for detection of coronary artery disease]. Rofo. 2002; 174(5):605-13. DOI: 10.1055/s-2002-28277. View

18.

Diamond G, Forrester J . Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979; 300(24):1350-8. DOI: 10.1056/NEJM197906143002402. View

19.

Hoffmann M, Shi H, Schmitz B, Schmid F, Lieberknecht M, Schulze R . Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005; 293(20):2471-8. DOI: 10.1001/jama.293.20.2471. View

20.

Mertes H, Sawada S, Ryan T, Segar D, Kovacs R, Foltz J . Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography. Experience in 1118 patients. Circulation. 1993; 88(1):15-9. DOI: 10.1161/01.cir.88.1.15. View