S H Kim1, J Rübenthaler1, D Nörenberg2, T Huber2, W G Kunz1, W H Sommer1, S O Schoenberg2, S Janssen2, D Overhoff2, M F Froelich3. 1. Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. 2. Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. 3. Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. matthias.froelich@medma.uni-heidelberg.de.
Abstract
OBJECTIVES: The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation. METHODS: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs. Cost-effectiveness was assessed based on a cost-effectiveness threshold of $100,000 per QALY. RESULTS: In the base-case scenario with willingness to pay of $100,000 per QALY, CTA resulted in total costs of $47,013.87 and an expected effectiveness of 6.84 QALYs, whereas CTP resulted in total costs of $46,758.83 with 6.93 QALYs. CTA + CTP reached costs of $47,455.63 with 6.85 QALYs. Therefore, strategies CTA and CTA + CTP were dominated by CTP in the base-case scenario. Deterministic sensitivity analysis demonstrated robustness of the model to variations of diagnostic efficacy parameters and costs in a broad range. CTP was cost-effective in the majority of iterations in the probabilistic sensitivity analysis as compared with CTA. CONCLUSIONS: CTP is cost-effective for the detection of obstructive CAD or ISR in patients with previous stenting and therefore should be considered a feasible approach in daily clinical practice. KEY POINTS: • CTP provides added diagnostic value in patients with previous coronary stents. • CTP is a cost-effective method for the detection of obstructive CAD or ISR in patients with previous stenting.
OBJECTIVES: The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation. METHODS: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs. Cost-effectiveness was assessed based on a cost-effectiveness threshold of $100,000 per QALY. RESULTS: In the base-case scenario with willingness to pay of $100,000 per QALY, CTA resulted in total costs of $47,013.87 and an expected effectiveness of 6.84 QALYs, whereas CTP resulted in total costs of $46,758.83 with 6.93 QALYs. CTA + CTP reached costs of $47,455.63 with 6.85 QALYs. Therefore, strategies CTA and CTA + CTP were dominated by CTP in the base-case scenario. Deterministic sensitivity analysis demonstrated robustness of the model to variations of diagnostic efficacy parameters and costs in a broad range. CTP was cost-effective in the majority of iterations in the probabilistic sensitivity analysis as compared with CTA. CONCLUSIONS:CTP is cost-effective for the detection of obstructive CAD or ISR in patients with previous stenting and therefore should be considered a feasible approach in daily clinical practice. KEY POINTS: • CTP provides added diagnostic value in patients with previous coronary stents. • CTP is a cost-effective method for the detection of obstructive CAD or ISR in patients with previous stenting.
Authors: Carsten Rist; Franz von Ziegler; Konstantin Nikolaou; Miles A Kirchin; Bernd J Wintersperger; Thorsten R Johnson; Andreas Knez; Alexander W Leber; Maximilian F Reiser; Christoph R Becker Journal: Acad Radiol Date: 2006-12 Impact factor: 3.173
Authors: Csilla Celeng; Tim Leiner; Pál Maurovich-Horvat; Béla Merkely; Pim de Jong; Jan W Dankbaar; Hendrik W van Es; Brian B Ghoshhajra; Udo Hoffmann; Richard A P Takx Journal: JACC Cardiovasc Imaging Date: 2018-09-12
Authors: Christian Tesche; Carlo N De Cecco; Moritz H Albrecht; Taylor M Duguay; Richard R Bayer; Sheldon E Litwin; Daniel H Steinberg; U Joseph Schoepf Journal: Radiology Date: 2017-10 Impact factor: 11.105
Authors: Alexia Rossi; Anoeshka Dharampal; Andrew Wragg; L Ceri Davies; Robert Jan van Geuns; Costantinos Anagnostopoulos; Ernst Klotz; Pieter Kitslaar; Alexander Broersen; Anthony Mathur; Koen Nieman; M G Myriam Hunink; Pim J de Feyter; Steffen E Petersen; Francesca Pugliese Journal: Eur Heart J Cardiovasc Imaging Date: 2013-08-09 Impact factor: 6.875
Authors: William S Weintraub; William E Boden; Zugui Zhang; Paul Kolm; Zefeng Zhang; John A Spertus; Pamela Hartigan; Emir Veledar; Claudine Jurkovitz; Jim Bowen; David J Maron; Robert O'Rourke; Marcin Dada; Koon K Teo; Ron Goeree; Paul G Barnett Journal: Circ Cardiovasc Qual Outcomes Date: 2008-09
Authors: Alexander R van Rosendael; Aukelien C Dimitriu-Leen; Michiel A de Graaf; Erik W van Zwet; J Wouter Jukema; Jeroen J Bax; Lucia J Kroft; Arthur J Scholte Journal: Eur Heart J Cardiovasc Imaging Date: 2017-09-01 Impact factor: 6.875
Authors: Gillian D Sanders; Peter J Neumann; Anirban Basu; Dan W Brock; David Feeny; Murray Krahn; Karen M Kuntz; David O Meltzer; Douglas K Owens; Lisa A Prosser; Joshua A Salomon; Mark J Sculpher; Thomas A Trikalinos; Louise B Russell; Joanna E Siegel; Theodore G Ganiats Journal: JAMA Date: 2016-09-13 Impact factor: 56.272
Authors: Ibrahim Danad; Jackie Szymonifka; Jos W R Twisk; Bjarne L Norgaard; Christopher K Zarins; Paul Knaapen; James K Min Journal: Eur Heart J Date: 2017-04-01 Impact factor: 35.855