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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

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.

Original languageEnglish (US)
Article number1
JournalJournal of Cardiovascular Magnetic Resonance
Volume24
Issue number1
DOIs
StatePublished - Dec 2022

Funding

This work was funded in part by a research grant provided by Novartis to S. Kelle at the German Heart Institute Berlin, Germany. CBD is in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. CBD is in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. S. Kelle receives research funding by Novartis and Philips Healthcare. S. E. Petersen provides consultancy to and is a shareholder of Circle Cardiovascular Imaging Inc, Calgary, Canada. J. Schwitter and E. Nagel receive research funding by Bayer Healthcare. J. White is a shareholder of Cohesic Inc. S. Kelle and E. Nagel are supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research). CBD is the Chief Executive Officer (part time) of the Society for Cardiovascular Magnetic Resonance (SCMR). JC was president of the Society for Cardiovascular Magnetic Resonance (SCMR) at the time this work was performed, receives research support from Bayer, Siemens, Guerbet, advisory board/lectures for Bayer, Siemens, Bracco. The other co-authors have no disclosures.

Keywords

  • Cardiovascular magnetic resonance
  • Coronary artery disease
  • Cost-effectiveness

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Family Practice

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