TY - JOUR
T1 - Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome
AU - Goehler, Alexander
AU - Mayrhofer, Thomas
AU - Pursnani, Amit
AU - Ferencik, Maros
AU - Lumish, Heidi S.
AU - Barth, Cordula
AU - Karády, Júlia
AU - Chow, Benjamin
AU - Truong, Quynh A.
AU - Udelson, James E.
AU - Fleg, Jerome L.
AU - Nagurney, John T.
AU - Gazelle, G. Scott
AU - Hoffmann, Udo
N1 - Publisher Copyright:
© 2020 Society of Cardiovascular Computed Tomography
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Methods: Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Results: Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10–1.17; 10-year: 5.06% vs. 5.21–5.36%; respectively). Conclusion: Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.
AB - Background: Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Methods: Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Results: Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10–1.17; 10-year: 5.06% vs. 5.21–5.36%; respectively). Conclusion: Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.
KW - Acute chest pain
KW - Acute coronary syndrome
KW - Coronary CTA
KW - Cost-effectiveness analysis
KW - Markov microsimulation model
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U2 - 10.1016/j.jcct.2019.06.008
DO - 10.1016/j.jcct.2019.06.008
M3 - Article
C2 - 31303580
AN - SCOPUS:85068540817
SN - 1934-5925
VL - 14
SP - 44
EP - 54
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 1
ER -