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Incremental cost-effectiveness of dobutamine stress cardiac magnetic resonance imaging in patients at intermediate risk for coronary artery disease.

Petrov G, Kelle S, Fleck E, Wellnhofer E - Clin Res Cardiol (2014)

Bottom Line: The primary effect was calculated as relative survival difference.Catheterizations ruling out CAD were significantly reduced by the CMR gate-keeper strategy.Lower costs at follow-up suggest sustained cost-effectiveness of the CMR-guided strategy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

ABSTRACT

Aims: The effectiveness of stress cardiac magnetic resonance (CMR) as a gatekeeper for coronary angiography (CA) has been established. Level five HTA studies according to the hierarchical model of diagnostic test evaluation are not available.

Methods: This cohort study included 1,158 consecutive patients (mean age 63 ± 11 years, 42 % women) presenting at our institution between January 1, 2003 and December 31, 2004 with suspected coronary artery disease (CAD) for an elective CA. The patients were assessed for eligibility and propensity score matching was applied to address selection bias regarding the patients' allocation to CMR or direct CA. Median patient follow-up was 7.9 years (95 % CI 7.8-8.0 years). The primary effect was calculated as relative survival difference. The cost unit calculation (per patient) at our institute was the source of costs.

Results: Survival was similar in CMR and CA (p = 0.139). Catheterizations ruling out CAD were significantly reduced by the CMR gate-keeper strategy. Patients with prior CMR had significantly lower costs at the initial hospital stay and at follow-up (CMR vs. CA, initial: 2,904 vs. 3,421, p = 0.018; follow-up: 2,045 vs. 3,318, p = 0.037). CMR was cost-effective in terms of a contribution of 12,466 per life year to cover a part of the CMR costs.

Conclusion: Stress CMR prior to CA was saving 12,466 of hospital costs per life year. Lower costs at follow-up suggest sustained cost-effectiveness of the CMR-guided strategy.

No MeSH data available.


Related in: MedlinePlus

Patient selection. 1,158 consecutive patients referred with suspected sCAD were assessed for eligibility. 843 patients of them remained after exclusion of factors, known to affect the CMR/CA allocation, and were adjusted on their risk probability for CAD by propensity score matching. After matching 502 patients at comparable risk were enrolled. Asterisk matching variables: age, gender, LVEF, angina pectoris, hypertension, hyperlipidemia, diabetes mellitus, smoking, ACE inhibitors, β blockers, calcium channel inhibitors, statins. LVEF left ventricular ejection fraction, ACE angiotensin converting enzyme
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Related In: Results  -  Collection


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Fig1: Patient selection. 1,158 consecutive patients referred with suspected sCAD were assessed for eligibility. 843 patients of them remained after exclusion of factors, known to affect the CMR/CA allocation, and were adjusted on their risk probability for CAD by propensity score matching. After matching 502 patients at comparable risk were enrolled. Asterisk matching variables: age, gender, LVEF, angina pectoris, hypertension, hyperlipidemia, diabetes mellitus, smoking, ACE inhibitors, β blockers, calcium channel inhibitors, statins. LVEF left ventricular ejection fraction, ACE angiotensin converting enzyme

Mentions: This retrospective cohort study is a controlled comparison of two different pathways for managing patients with sCAD and intermediate event risk. The term “intermediate event risk” refers to the risk of annual all-cause mortality of ≥1 but ≤3 % as suggested by the guidelines on the management of sCAD [16]. The source population includes 1,158 consecutive patients referred to the German Heart Institute Berlin between January 1, 2003 and December 31, 2004. Inclusion criteria were sCAD and sufficient data on age, gender, symptoms, cardiovascular (CV) risk factors and medical therapy. Exclusion criteria were known CAD verified by previous angiography, LV ejection fraction (LVEF) ≤40 %, history of cardiac transplantation or an indication different from sCAD for CA. Finally, 843 eligible patients were adjusted for selection bias by propensity score matching and 502 patients remained (CMR: 209 pts. vs. CA: 293 pts.; Fig. 1). The study was approved by the Charité University Hospital Ethics Committee and complies with the principles outlined in the Declaration of Helsinki.Fig. 1


Incremental cost-effectiveness of dobutamine stress cardiac magnetic resonance imaging in patients at intermediate risk for coronary artery disease.

Petrov G, Kelle S, Fleck E, Wellnhofer E - Clin Res Cardiol (2014)

Patient selection. 1,158 consecutive patients referred with suspected sCAD were assessed for eligibility. 843 patients of them remained after exclusion of factors, known to affect the CMR/CA allocation, and were adjusted on their risk probability for CAD by propensity score matching. After matching 502 patients at comparable risk were enrolled. Asterisk matching variables: age, gender, LVEF, angina pectoris, hypertension, hyperlipidemia, diabetes mellitus, smoking, ACE inhibitors, β blockers, calcium channel inhibitors, statins. LVEF left ventricular ejection fraction, ACE angiotensin converting enzyme
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4544498&req=5

Fig1: Patient selection. 1,158 consecutive patients referred with suspected sCAD were assessed for eligibility. 843 patients of them remained after exclusion of factors, known to affect the CMR/CA allocation, and were adjusted on their risk probability for CAD by propensity score matching. After matching 502 patients at comparable risk were enrolled. Asterisk matching variables: age, gender, LVEF, angina pectoris, hypertension, hyperlipidemia, diabetes mellitus, smoking, ACE inhibitors, β blockers, calcium channel inhibitors, statins. LVEF left ventricular ejection fraction, ACE angiotensin converting enzyme
Mentions: This retrospective cohort study is a controlled comparison of two different pathways for managing patients with sCAD and intermediate event risk. The term “intermediate event risk” refers to the risk of annual all-cause mortality of ≥1 but ≤3 % as suggested by the guidelines on the management of sCAD [16]. The source population includes 1,158 consecutive patients referred to the German Heart Institute Berlin between January 1, 2003 and December 31, 2004. Inclusion criteria were sCAD and sufficient data on age, gender, symptoms, cardiovascular (CV) risk factors and medical therapy. Exclusion criteria were known CAD verified by previous angiography, LV ejection fraction (LVEF) ≤40 %, history of cardiac transplantation or an indication different from sCAD for CA. Finally, 843 eligible patients were adjusted for selection bias by propensity score matching and 502 patients remained (CMR: 209 pts. vs. CA: 293 pts.; Fig. 1). The study was approved by the Charité University Hospital Ethics Committee and complies with the principles outlined in the Declaration of Helsinki.Fig. 1

Bottom Line: The primary effect was calculated as relative survival difference.Catheterizations ruling out CAD were significantly reduced by the CMR gate-keeper strategy.Lower costs at follow-up suggest sustained cost-effectiveness of the CMR-guided strategy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

ABSTRACT

Aims: The effectiveness of stress cardiac magnetic resonance (CMR) as a gatekeeper for coronary angiography (CA) has been established. Level five HTA studies according to the hierarchical model of diagnostic test evaluation are not available.

Methods: This cohort study included 1,158 consecutive patients (mean age 63 ± 11 years, 42 % women) presenting at our institution between January 1, 2003 and December 31, 2004 with suspected coronary artery disease (CAD) for an elective CA. The patients were assessed for eligibility and propensity score matching was applied to address selection bias regarding the patients' allocation to CMR or direct CA. Median patient follow-up was 7.9 years (95 % CI 7.8-8.0 years). The primary effect was calculated as relative survival difference. The cost unit calculation (per patient) at our institute was the source of costs.

Results: Survival was similar in CMR and CA (p = 0.139). Catheterizations ruling out CAD were significantly reduced by the CMR gate-keeper strategy. Patients with prior CMR had significantly lower costs at the initial hospital stay and at follow-up (CMR vs. CA, initial: 2,904 vs. 3,421, p = 0.018; follow-up: 2,045 vs. 3,318, p = 0.037). CMR was cost-effective in terms of a contribution of 12,466 per life year to cover a part of the CMR costs.

Conclusion: Stress CMR prior to CA was saving 12,466 of hospital costs per life year. Lower costs at follow-up suggest sustained cost-effectiveness of the CMR-guided strategy.

No MeSH data available.


Related in: MedlinePlus