Cost analysis of cardiac MRI for cardiac transplant surveillance

Abstract

National health expenditures in the United States have risen steadily since 1960. While lifesaving therapies exist for acquired and congenital heart diseases, for some children heart transplantation is their only chance for a period of durable survival. Like many advanced therapies, however, heart transplantation confers a significant cost to families and the health care system at large. Current heart transplant health surveillance relies on frequent cardiac catheterization with endomyocardial biopsy (cath-EMB) as periodic assessment of graft health and detection of possible life-threatening acute rejection. Cardiac magnetic resonance imaging (MRI) has emerged as a diagnostic tool which can characterize the myocardium, providing insights into graft health and potentially acute/chronic graft rejection. The PEACE study (R01-HL164995-02) aims to systematically evaluate the potential for using cardiac MRI parametric mapping as a pre-cath-EMB screening tool to alleviate both patient anxiety and discomfort, as well as the financial burden of cath-EMB. The PEACE trial aims to establish definitive evidence and criteria for determining when cath EMB is needed. For a technique to be practical in the real world, though, it must also be cost effective.Therefore, the goal of this current research is to determine a minimal set of measurement properties (positive predictive value (PPV), etc.) that cardiac MRI must attain to be cost-effective. These data will guide the decision-making for the PEACE trial results. Consistent with the recent emphasis on “Value MRI,” we sought to understand the potential Medicare savings, through economic cost analysis modeling, if cardiac MRI is used for cardiac transplant surveillance rather than cath-EMB surveillance. At even the most pessimistic positive test rate for MRI considered, these modeling results suggest substantial Medicare cost savings when using cardiac MRI parametric mapping as a screening tool for detecting acute cardiac rejection. Longitudinal cost savings are notable too.