Cost-minimization analysis of three decision strategies for cardiac revascularization: results of the “suspected CAD” cohort of the european cardiovascular magnetic resonance registry

Journal of Cardiovascular Magnetic Resonance

Research

Raymond Y. Kwong¹  Guenter Pilz²  Heiko Mahrholdt³  Juerg Schwitter⁴  Oliver Bruder⁵  Karine Moschetti⁶  Massimo Lombardi⁷  Jean-Blaise Wasserfallen⁸  Grigorios Korosoglou⁹  Albert C. Van Rossum^1,10  Steffen E. Petersen^1,11 

[1] Brigham and Women’s Hospital, Harvard Medical School, Boston, USA;Clinic Agatharied, Academic Teaching Hospital, University of Munich, Munich, Germany;Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany;Division of Cardiology, Director Cardiac MR Center, University Hospital Lausanne - CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland;Elisabeth Hospital, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Essen, Germany;Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Lausanne, Switzerland;Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland;Policlinics of San Donato, Italian Research Hospital, Milano, Italy;Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland;University Hospital of Heidelberg, Heidelberg, Germany;VU University Medical Center, Amsterdam, The Netherlands;William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, UK;

关键词: Cardiovascular Magnetic Resonance;    Fractional Flow Reserve;    Stable Coronary Artery Disease;    Percutaneous Coronary Intervention;    Suspected Coronary Artery Disease;   

DOI  :  10.1186/s12968-015-0222-1

 received in 2015-08-16, accepted in 2015-12-22,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCoronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry.MethodsIn 3’647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50 % stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50 % stenoses. To calculate the proportion of patients with ≥50 % stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems.ResultsRevascularizations were performed in 6.2 %, 4.5 %, and 12.9 % of all patients, patients with atypical chest pain (n = 1’786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3 %, 1.1 %, and 1.5 %, respectively. The CMR + CXA-strategy reduced costs by 14 %, 34 %, 27 %, and 24 % in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59 %, 52 %, 61 % and 71 %, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3 %), intermediate in the US and Swiss (11.6 % and 12.8 %, respectively), and remained substantial in the UK (18.9 %) systems. Sensitivity analyses proved the robustness of results.ConclusionsA CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.

【 授权许可】

CC BY   
© Moschetti et al. 2016