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

  • Ankur Pandya (Creator)
  • Yuan Jui Yu (Creator)
  • Yin Ge (Creator)
  • E. Nagel (Creator)
  • Raymond Y. Kwong (Creator)
  • Rafidah Abu Bakar (Creator)
  • John D. Grizzard (Creator)
  • Alexander E. Merkler (Creator)
  • Ntobeko Ntusi (Creator)
  • Steffen E. Petersen (Creator)
  • Nina Rashedi (Creator)
  • Juerg Schwitter (Creator)
  • Joseph B. Selvanayagam (Creator)
  • James A. White (Creator)
  • James Carr (Creator)
  • Subha V. Raman (Creator)
  • Orlando Simonetti (Creator)
  • C. Bucciarelli-Ducci (Creator)
  • Lilia M. Sierra-Galan (Creator)
  • Victor A. Ferrari (Creator)
  • Mona Bhatia (Creator)
  • Sebastian Kelle (Creator)



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.
Date made available2022

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