Key result
First-line functional imaging like CMR is cost-effective for stable CAD, unlike direct invasive angiography.
Why the study?
Given recent data on published diagnostic accuracies, the study sought to determine the most cost-effective diagnostic strategy for detecting significant CAD in stable angina patients using ICA and FFR as the reference standard.
What is the most cost-effective diagnostic strategy for detecting significant CAD in patients with stable angina?
What is the most cost-effective diagnostic strategy for detecting significant CAD in patients with stable angina?
First-line testing with functional imaging is cost-effective for diagnosing significant CAD in patients with low to intermediate risk.
May support functional imaging first-line in low-intermediate risk stable CAD; extends decision models but leaves open prospective validation.
OBJECTIVE: Given recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the reference standard. METHODS: A probabilistic decision-analytical model was developed which modelled a cohort of patients with stable angina. We investigated 17 diagnostic strategies between standalone and combination of different imaging tests to establish a correct diagnosis of CAD, using no testing as the baseline reference. These tests included CT coronary angiography (CTCA), stress echocardiography, CT-based FFR, single-photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), positron emission tomography, ICA, and ICA with FFR. Incremental cost-effectiveness ratios were calculated as the additional cost per correct diagnosis. RESULTS: SPECT followed by CTCA and ICA-FFR is the most cost-effective strategy between a cost-effectiveness threshold (CET) value of £1000-£3000 per correct diagnosis. CMR followed by CTCA and ICA-FFR is cost-effective within a CET range of £3000-£17 000 per correct diagnosis. CMR and ICA-FFR is cost-effective within a CET range of £17 000-£24 000. ICA-FFR as first line is the most-cost effective if the CET value exceeds the £24 000 per correct diagnosis. Sensitivity analysis showed that direct ICA-FFR may be cost-effective in patients with a high pre-test probability of CAD. CONCLUSION: First-line testing with functional imaging is cost-effective at low to intermediate value of correct diagnosis in patients with low to intermediate risk of CAD. ICA is not cost effective although ICA-FFR may be at higher CET.
No takes yet. Share an insight, caveat, or question.
Nazir et al. (2022) studied Suspected stable coronary artery disease. Non-invasive functional imaging diagnostic strategies (e.g., CMR, SPECT, CTCA) vs. No testing and direct invasive coronary angiography (ICA) was evaluated on Expected proportion of correct diagnoses and incremental cost-effectiveness ratio (ICER). First-line testing with functional imaging like CMR is cost-effective (£3,000 to £24,000 per correct diagnosis) for stable CAD at low to intermediate pretest probability, while direct invasive coronary angiography is not.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: