Why the study?
Germany has the highest per capita volume of coronary angiographies despite similar stable coronary artery disease prevalence across European countries, prompting evaluation of the health economic impact of guideline-non-adherent use.
Does complete guideline-adherent use of coronary angiography reduce MACE and costs compared to real-world use in patients with suspected SCAD?
Does complete guideline-adherent use of coronary angiography reduce MACE and costs compared to real-world use in patients with suspected SCAD?
Effect estimate: MACE rate difference -0.0017; cost difference €-807
Improving guideline adherence by reducing unnecessary coronary angiographies in patients with suspected SCAD leads to cost savings and slightly fewer adverse events.
Non-adherent CA in SCAD raises costs; leaves open whether adherence improves outcomes in randomized trials.
AIMS: While the number of patients with stable coronary artery disease (SCAD) is similar across European countries, Germany has the highest per capita volume of coronary angiographies (CA). This study evaluated the health economic consequences of guideline-non-adherent use of CA in patients with SCAD. METHODS AND RESULTS: As part of the ENLIGHT-KHK trial, a prospective observational study, this microsimulation model compared the number of major adverse cardiac events (MACE) and the costs of real-world use of CA with those of (assumed) complete guideline-adherent use (according to the German National Disease Management Guideline 2019). The model considered non-invasive testing, CA, revascularization, MACE (30 days after CA), and medical costs. Model inputs were obtained from the ENLIGHT-KHK trial (i.e. patients' records, a patient questionnaire, and claims data). Incremental cost-effectiveness ratios were calculated by comparing the differences in costs and MACE avoided from the perspective of the Statutory Health Insurance (SHI). Independent on pre-test probability (PTP) of SCAD, complete guideline adherence for usage of CA would result in a slightly lower rate of MACE (-0.0017) and less cost (€-807) per person compared with real-world guideline adherence. While cost savings were shown for moderate and low PTP (€901 and €502, respectively), for a high PTP, a guideline-adherent process results in slightly higher costs (€78) compared with real-world guideline adherence. Sensitivity analyses confirmed the results. CONCLUSION: Our analysis indicates that improving guideline adherence in clinical practice by reducing the amount of CAs in patients with SCAD would lead to cost savings for the German SHI.
No takes yet. Share an insight, caveat, or question.
Seleznova et al. (2023) studied Suspected obstructive stable coronary artery disease. Complete guideline-adherent use of coronary angiography vs. Real-world use of coronary angiography was evaluated on Major adverse cardiac events (MACE) and costs (MACE rate difference -0.0017; cost difference €-807). Complete guideline adherence for coronary angiography in suspected SCAD would lower MACE rates (-0.0017) and reduce costs (€-807 per person) compared with real-world use.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: