Abstract
BackgroundCardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD.MethodsA subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings.ResultsIn the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA.ConclusionThis analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.
Highlights
Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected Coronary artery disease (CAD)
The present analysis focused on patients with clinically suspected CAD who had a stress cardiovascular magnetic resonance (CMR) test
When the CMR test is performed by public hospitals as a pre-inpatient test and Coronary angiography (CXA) as an outpatient test, the CMR strategy still remains less costly by 11%
Summary
Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. In Germany, the total number of invasive coronary angiography (CXA) performed in 2008 accounted for reimbursement costs of over 500 Mio. Euros [6]. In the United Kingdom, the last available figures on hospitals activities enable to estimate that more than 58% of the performed CXA tests did not lead to invasive cardiac procedures (PCI or CABG) afterwards [1,23]. This suggests that for a considerable number of patients, CXA may not be appropriate. CXA has some disadvantages such as exposure to radiation, bleeding, and contrast nephropathy
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