Adenosine-stress cardiac magnetic resonance imaging in the assessment of coronary artery disease: A net cost analysis and reimbursement implications

Abstract

Methods 218 patients from a registry on 605 consecutive CMR patients were matched to a prior sample in which CMR was demonstrated to reliably stratify patients regarding their risk of major cardiac events [1]. Propensity scoring methods were used to match on comorbidity profiles, demographics, CAD-related clinical presentation, and CAD risk as measured by their Morise scores. The matched sample included adult subjects with suspected CAD who were evaluated by stress CMR. We identified the proportion of patients who were able to avoid cardiac catheterization based upon the results of their CMR tests. Given this information, and data on the costs of cardiac catheterization and CMR tests, a net cost analysis was performed. Results CMR use substantially reduces the need for cardiac catheterization by 62.4%. Assuming catheterization costs of EUR 619 based on Diagnosis Related Groups (DRG) reimbursement rates in Germany, use of CMR leads to cost savings of EUR 90 on average. The breakeven-level for CMR costs at which it is cost neutral is EUR 386. These results were robust in sensitivity analysis. Cost savings are greatest for patients with lowest risk of CAD as measured by their baseline Morise scores. However, cost savings are likely for all Morise sub groups examined, with the exception of patients at the highest risk of CAD as measured by their Morise score.