Key result
Cardiovascular magnetic resonance was the dominant, cost-effective strategy compared with NICE guidelines, yielding an incremental net health benefit of 0.146 QALYs (95% CI -0.18 to 0.406).
Why the study?
The cost-effectiveness of cardiovascular imaging strategies including CMR, MPS, and NICE guideline-guided care for patients with suspected CHD was unclear.
Does cardiovascular magnetic resonance (CMR) improve cost-effectiveness in patients presenting with chest pain and suspected coronary heart disease compared to MPS or NICE guidelines?
Does cardiovascular magnetic resonance (CMR) improve cost-effectiveness in patients presenting with chest pain and suspected coronary heart disease compared to MPS or NICE guidelines?
Mean Difference: 0.146 (95% CI -0.18–0.406)
Absolute Event Rate: 2.21% vs 2.07%
CMR-guided care is a cost-effective strategy for managing patients with suspected coronary heart disease compared to MPS and standard guideline-directed care.
OBJECTIVE: To assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care. METHODS: Using UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016-2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups. RESULTS: CMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (-0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups. CONCLUSIONS: CMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.
No takes yet. Share an insight, caveat, or question.
Walker et al. (2020) studied chest pain and suspected coronary heart disease (CHD) (n=1,202). Cardiovascular magnetic resonance (CMR) vs. Myocardial perfusion scintigraphy (MPS) and NICE guideline-guided care was evaluated on Quality-adjusted life-years (QALYs) (incremental net health benefit 0.146 QALYs, 95% CI -0.18, 0.406). Cardiovascular magnetic resonance was the dominant, cost-effective strategy compared with NICE guidelines, yielding an incremental net health benefit of 0.146 QALYs (95% CI -0.18 to 0.406).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: