Cost minimization analysis of beta-blocker at the time of CT imaging for suspected of coronary heart disease in Japan

Figures & data

Figure 1. Critical pathway for the diagnosis of coronary stenosis.

Figure 2. Decision tree model for administering beta-blockers to patients suspected of ischemic heart disease.

Table 1. Cost comparison of Computed Tomography Coronary Angiography (CTCA) and coronary angiography Coronary Angiography (CAG) imaging.

	Cost (JPY)**	Cost (USD)
Computed Tomography Coronary Angiography (CTCA)
Multi-slice CT imaging fee (>64 rows)	9,500	95
additional fee for contrasting agent* (including administration fee)	5,000	50
CT diagnosis fee	4,500	45
additional fee for management of diagnostic imaging*	1,800	18
Fee for computer imaging (applicable when CT image is electrically managed and saved without any film)	1,200	12
Contrasting agent (iopamidol 100 mL × 1)	10,116	101.16
Total medical cost	38,116	381.16 (>64 rows)
Coronary Angiography (CAG)
Left heart catheterization (including administration fee of contrasting agent, imaging and diagnosis fee)	40,000	400
Fee for devices
angiographaic catheter (for general use)	2,880	28.8
angiographic guidewire (for replacement)	3,880	38.8
sheathe introducer	3,010	30.1
Hospitalization fee (3 days, 7 nurses per 1 patient)	31,320	313.2
Contrasting agent (iopamidol 100 mL × 2)	20,232	202.32
Total medical cost	101,322	1013.22

*Can be charged once per month.

**Shakai-hoken-kenkyujyo. Ika Shinryo hoshu tensu hyo Heisei-24-nen-4-gatsu-ban. Shakai-hoken-kenkyujyo, 2012 [in Japanese]7.

CT, Computed Tomography.

[USD1 = JPY100 as of November 20, 2013].

Table 2. Results of one-way sensitivity analyses.

	Best	Base line	Worst
CAG cost, JPY (JPY101,322–JPY107,082)	−3,292 (JPY 101,322)	−3,292 (JPY 101,322)	−3,512 (JPY 107,082)
Patients with bradycardia, percentage (21.3–23.8%)	−3,122 (21.3%)	−3,292 (22.5%)	−3,213 (23.8%)
Landiolol effective, percentage (77.8–84.9%)	−2,782 (77.8%)	−3,292 (81.4%)	−3,799 (84.9%)
Efficacy rate of placebo, percentage (49.7–58.8%)	−3,941 (49.7%)	−3,292 (54.2%)	−2,638 (58.8%)
CTCA positive, percentage (32.0–42.2%)	−3,605 (32.0%)	−3,292 (37.1%)	−2,975 (42.2%)

Shakai-hoken-kenkyujyo. Ika Shinryo hoshu tensu hyo Heisei-24-nen-4-gatsu-ban. Shakai-hoken-kenkyujyo, Institute of social insurance, Tokyo. 2012 [in Japanese]. Institute of social insurance. National tariff of medical fees 2012. Tokyo, Japan: Institute of Social Insurance, 2012

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