64-Slice CT coronary angiography versus conventional coronary angiography: activity-based cost analysis

Abstract

This study was done to analyse the costs of 64-slice computed tomography (CT) coronary angiography and conventional coronary angiography and determine the cost-effectiveness of the two modalities. Detailed activity-based cost analyses of the two modalities were carried out at the departments of radiology and cardiology of a teaching hospital. The differential costs (equipment, variable, personnel), common costs and external costs were estimated. Finally, the full costs of the two procedures were obtained; the full cost of conventional coronary angiography also considered the cost of 1 day in hospital. The cost-effectiveness of the two procedures at different levels of pretest likelihood of coronary artery disease (CAD) was estimated. The costs of multidetector CT (MDCT) coronary angiography were as follows: differential cost 222.23 euro, common cost 5.50 euro, external cost 2.30 euro and full cost 230.03 euro. The costs of conventional coronary angiography were: differential cost 366.18 euro, common cost 0.50 euro, external cost 9.20 euro, hospitalisation cost 1,652 euro and full cost 2,027.88 euro. Cost-effectiveness analysis showed that the cost per correctly identified CAD patient decreased exponentially with increasing pretest likelihoods of CAD. MDCT coronary angiography was more cost effective than conventional coronary angiography up to a pretest likelihood of 86%. MDCT coronary angiography has far lower costs than conventional coronary angiography, and its cost-effectiveness is better in the large majority of patients.