The cost–effectiveness of diagnostic cardiac imaging for stable coronary artery disease

Abstract

Early and accurate diagnosis of stable coronary artery disease (CAD) is crucial to reduce morbidity, mortality and healthcare costs. This critical appraisal of health-economic literature concerning non-invasive diagnostic cardiac imaging aims to summarize current approaches to economic evaluation of diagnostic cardiac imaging and associated procedural risks, inform cardiologists how to use economic analyses for decision-making, highlight areas where new information could strengthen the economic evaluation and shed light on cost-effective approaches to diagnose stable CAD. Economic analysis can support cardiologists’ decision-making. Current economic evidence in the field does not provide sufficient information to guide the choice among different imaging modalities or strategies for each patient. Available economic analyses suggest that computed tomography coronary angiography (CTCA) is a cost-effective approach to rule out CAD prior to invasive coronary angiography in patients with low to intermediate pre-test probability of disease and that stress imaging modalities may be cost-effective at variable pre-test probabilities.

Keywords:

• coronary heart disease
• diagnostic cardiac imaging
• economic analysis
• procedural risk
• systematic review

Acknowledgements

We thank B Moore for her writing support.

Financial & competing interests disclosure

GI Wilson and AC Sweet are employees of GE Healthcare. AM Chapman was an employee of GE Healthcare at the time of drafting the manuscript. MA Kroes is a full-time employee of Abacus International and received funding from GE Healthcare to conduct the systematic literature review. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Coronary artery disease (CAD) is responsible for a considerable clinical and economic burden within the EU, accounting each year for at least 681,000 deaths and a cost of almost €38 billion a year.

• Several non-invasive tests for the diagnosis of CAD are currently available and could be used as a gatekeeper for invasive examination, to prevent unnecessary risks and potentially aid cost containment.

• Cost–effectiveness of single non-invasive tests in symptomatic patients has been investigated, and the present review identified 33 studies published in peer-reviewed journals during the last decade.

• Available studies are characterized by a high degree of variability (outcomes measures, costs estimation, etc.) and generally low methodological quality.

• Further investigation is needed to elucidate the comparative cost–effectiveness of (combination of) non-invasive tests for the detection of CAD in symptomatic patients.