Abstract
BackgroundThe procedural numbers and medical costs of percutaneous coronary intervention (PCI), mainly elective PCI, have been increasing in Japan. Owing to increased interest in the appropriateness of coronary revascularization, we conducted this medical economics-based evaluation of testing and diagnosis of stable coronary artery disease (CAD). Methods and ResultsWe reviewed patients’ medical insurance data to identify stable CAD patients who underwent coronary computed tomography angiography, cardiac single-photon emission computed tomography, coronary angiography, or fractional flow reserve. Subjects were divided into anatomical and functional evaluation groups according to the modality of testing, and background factors were matched by propensity score. The endpoints were major adverse cardiovascular events (MACE), life years (LYs), medical costs, and cost-effectiveness analysis (CEA). The observations were performed for 36 months. MACE, medical costs, and CEA of the functional group in the overall category were trending to be better than the anatomical group (MACE, P = .051; medical costs: 3,105 US$ vs 4,430 US$, P = .007; CEA: 2,431 US$/LY vs 2,902 US$/LY, P = .043). ConclusionsThe functional evaluation approach improved long-term clinical outcomes and reduced cumulative medical costs. As a result, the modality composition of functional myocardial ischemia evaluation was demonstrated to offer superior cost-effectiveness in stable CAD.
Highlights
As a result of the remarkable increase in the aging population and lifestyle habit changes in Japan, coronary revascularization was performed on 296,743 patients in 2018, or 234.7 cases/year per 100,000 population.[1]
Likewise, when invasive diagnostic approaches were considered (Category C), the functional group (FFR/ SPECT group) had more favorable results on MACE, coronary revascularization, total medical costs, hospitalization costs, and cost-effectiveness analysis (CEA) compared to the anatomical group (CAG group)
The patient backgrounds in Category C, consisting of patients undergoing invasive diagnostic testing, were matched between the coronary angiography (CAG) and fractional flow reserve (FFR)/SPECT groups for pre-testing ECG and post-testing antiplatelet agent prescription in each modality. This determined the pre-test probability of cardiac catheter testing. These analyses clearly found that the FFR/ SPECT group less frequently underwent percutaneous coronary intervention (PCI) than did the CAG group, as shown previously.[5,6,9]
Summary
As a result of the remarkable increase in the aging population and lifestyle habit changes in Japan, coronary revascularization was performed on 296,743 patients in 2018, or 234.7 cases/year per 100,000 population (as of October 2018).[1] Of the 278,285 percutaneous coronary intervention (PCI) procedures performed in 2018, elective PCI indicated for patients with stable coronary artery disease (CAD) accounted for a large proportion (72.4%) of these procedures. Owing to increased interest in the appropriateness of coronary revascularization, we conducted this medical economics-based evaluation of testing and diagnosis of stable coronary artery disease (CAD)
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