Abstract
With the need for healthcare cost-containment, increased scrutiny will be placed on new medical therapeutic or diagnostic technologies. Several challenges exist for a new diagnostic test to demonstrate cost-effectiveness. New diagnostic tests differ from therapeutic procedures due to the fact that diagnostic tests do not generally directly affect long-term patient outcomes. Instead, the results of diagnostic tests can influence management decisions for patients and by this route, diagnostic tests indirectly affect long-term outcomes. The benefits from a specific diagnostic technology depend therefore not only on its performance characteristics, but also on other factors such as prevalence of disease, and effectiveness of existing treatments for the disease of interest. We review the concepts and theories of cost-effectiveness analyses (CEA) as they apply to diagnostic tests in general. The limitations of CEA across different study designs and geographic regions are discussed, and we also examine the strengths and weakness of the existing publications where CMR was the focus of CEA compared to other diagnostic options.
Highlights
With the need for healthcare cost-containment, increased scrutiny will be placed on new medical therapeutic or diagnostic technologies
Despite rapid growth in advanced cardiac imaging modalities (e.g., CT/cardiovascular magnetic resonance (CMR)/PET), these modalities accounted for a small percentage of the increased cost, relative to nuclear stress imaging and echocardiography
Multicenter evidence from the MR-IMPACT 2 trial demonstrated superior sensitivity but inferior specificity of stress perfusion CMR compared to Single photon emission computed tomography (SPECT) in the context of suspected CAD [32]
Summary
Associated with this rapid increase in cardiac imaging in the past decade [6]. In the past decades, very few studies have made the effort of relating the growth in imaging to direct, costeffective improvement in patient care. It is clear that cost-effectiveness analysis is critical for the appropriate use of cardiac imaging This is relevant for the future growth of CMR, given its costs and the increasing scrutiny from third party payers. As a result many health economists prefer cost effectiveness which describes the relationship between cost and a measure of health relevant to the intervention being analyzed such as life-years gained, disease free survival in a cancer treatment study, or reductions in blood pressure in a trial of an anti-hypertensive. One example of a registry resource that contains independently-reviewed information on QALY, utility weighting, and other metrics relevant to CEA under various disease classification, is the Cost-Effectiveness Analysis Registry developed by the Institute for Clinical Research and Health Policy Studies of Tufts Medical Center in Boston (https://research.tuftsnemc.org/cear). The societal perspective looks at the aggregate costs and effects on all members and is the one most often employed in CEA [14]
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