A diagnostic strategy of exercise treadmill testing followed by cardiac magnetic resonance imaging was the dominant (least costly and most effective) approach for diagnosing coronary heart disease.
Is a diagnostic strategy incorporating CMR cost-effective compared to strategies using SPECT or direct CA in patients with suspected stable angina?
A diagnostic strategy utilizing CMR after an inconclusive ETT is the most cost-effective approach for evaluating stable angina compared to SPECT or direct angiography.
AIMS: The aim of this study was to assess the cost-effectiveness of eight common diagnostic work-up strategies for coronary heart disease (CHD) in patients with stable angina symptoms in Switzerland. METHODS AND RESULTS: A decision analytical model was used to perform a cost-effectiveness comparison of eight common multitest strategies to diagnose CHD using combinations of four diagnostic techniques: exercise treadmill test (ETT), single-photon emission computed tomography (SPECT), cardiac magnetic resonance imaging (CMR), and coronary angiography (CA). We used a Markov state transition model to extrapolate the results over a life-time horizon, from a third-party payer perspective. We used a CHD prevalence rate of 39% in patients and a base-case scenario with 60-year-old male patients with intermediate symptom severity Canadian Cardiovascular Society grading of angina pectoris 2 and at least one cardiovascular (CV) risk factor but without a history of myocardial infarction and without need for revascularization. Among the eight work-up strategies, one strategy was dominant, i.e. least costly and most effective: ETT followed by CMR if the ETT result was inconclusive and then CA if the CMR result was positive or inconclusive. The CMR features a favourable balance between false-negative diagnoses, associated with an elevated risk of CV events, and false-positive diagnoses, leading to unnecessary CA and related mortality. Key parameters guiding the diagnostic strategy are the prevalence of CHD in patients with angina symptoms and the diagnostic costs of CA and CMR. CONCLUSION: Cardiac magnetic resonance imaging appears to be a cost-effective work-up strategy compared with other regimens using SPECT or direct CA. Cardiac magnetic resonance imaging should be more widely recommended as a diagnostic procedure for patients with suspected angina symptoms.
Pletscher et al. (Thu,) conducted a other in Coronary heart disease. Exercise treadmill test (ETT) followed by cardiac magnetic resonance imaging (CMR) vs. Other diagnostic strategies using SPECT or direct coronary angiography was evaluated on Cost-effectiveness. A diagnostic strategy of exercise treadmill testing followed by cardiac magnetic resonance imaging was the dominant (least costly and most effective) approach for diagnosing coronary heart disease.