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Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes.

Publication ,  Journal Article
Ge, Y; Pandya, A; Steel, K; Bingham, S; Jerosch-Herold, M; Chen, Y-Y; Mikolich, JR; Arai, AE; Bandettini, WP; Patel, AR; Farzaneh-Far, A ...
Published in: JACC Cardiovasc Imaging
July 2020

OBJECTIVES: The aim of this study was to compare, using results from the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, the incremental cost-effectiveness of a stress cardiovascular magnetic resonance (CMR)-first strategy against 4 other clinical strategies for patients with stable symptoms suspicious for myocardial ischemia: 1) immediate x-ray coronary angiography (XCA) with selective fractional flow reserve for all patients; 2) single-photon emission computed tomography; 3) coronary computed tomographic angiography with selective computed tomographic fractional flow reserve; and 4) no imaging. BACKGROUND: Stress CMR perfusion imaging has established excellent diagnostic utility and prognostic value in coronary artery disease (CAD), but its cost-effectiveness in current clinical practice has not been well studied in the United States. METHODS: A decision analytic model was developed to project health care costs and lifetime quality-adjusted life years (QALYs) for symptomatic patients at presentation with a 32.4% prevalence of obstructive CAD. Rates of clinical events, costs, and quality-of-life values were estimated from SPINS and other published research. The analysis was conducted from a U.S. health care system perspective, with health and cost outcomes discounted annually at 3%. RESULTS: Using hard cardiovascular events (cardiovascular death or acute myocardial infarction) as the endpoint, total costs per person were lowest for the no-imaging strategy ($16,936) and highest for the immediate XCA strategy ($20,929). Lifetime QALYs were lowest for the no-imaging strategy (12.72050) and highest for the immediate XCA strategy (12.76535). The incremental cost-effectiveness ratio for the CMR-based strategy compared with the no-imaging strategy was $52,000/QALY, whereas the incremental cost-effectiveness ratio for the immediate XCA strategy was $12 million/QALY compared with CMR. Results were sensitive to variations in model inputs for prevalence of disease, hazard rate ratio for treatment of CAD, and annual discount rate. CONCLUSIONS: Prior to invasive XCA, stress CMR can be a cost-effective gatekeeping tool in patients at risk for obstructive CAD in the United States. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

1505 / 1517

Location

United States

Related Subject Headings

  • Predictive Value of Tests
  • Myocardial Perfusion Imaging
  • Magnetic Resonance Imaging
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Cost-Benefit Analysis
  • Coronary Artery Disease
  • Coronary Angiography
  • Chest Pain
  • Cardiovascular System & Hematology
 

Citation

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Ge, Y., Pandya, A., Steel, K., Bingham, S., Jerosch-Herold, M., Chen, Y.-Y., … Kwong, R. Y. (2020). Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes. JACC Cardiovasc Imaging, 13(7), 1505–1517. https://doi.org/10.1016/j.jcmg.2020.02.029
Ge, Yin, Ankur Pandya, Kevin Steel, Scott Bingham, Michael Jerosch-Herold, Yi-Yun Chen, J Ronald Mikolich, et al. “Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes.JACC Cardiovasc Imaging 13, no. 7 (July 2020): 1505–17. https://doi.org/10.1016/j.jcmg.2020.02.029.
Ge Y, Pandya A, Steel K, Bingham S, Jerosch-Herold M, Chen Y-Y, et al. Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes. JACC Cardiovasc Imaging. 2020 Jul;13(7):1505–17.
Ge, Yin, et al. “Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes.JACC Cardiovasc Imaging, vol. 13, no. 7, July 2020, pp. 1505–17. Pubmed, doi:10.1016/j.jcmg.2020.02.029.
Ge Y, Pandya A, Steel K, Bingham S, Jerosch-Herold M, Chen Y-Y, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Hachamovitch R, Stuber M, Simonetti OP, Kwong RY. Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes. JACC Cardiovasc Imaging. 2020 Jul;13(7):1505–1517.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

1505 / 1517

Location

United States

Related Subject Headings

  • Predictive Value of Tests
  • Myocardial Perfusion Imaging
  • Magnetic Resonance Imaging
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Cost-Benefit Analysis
  • Coronary Artery Disease
  • Coronary Angiography
  • Chest Pain
  • Cardiovascular System & Hematology