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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

a Long-term survival of CMR and CA patients. Survival probability (depicted on the x-axis) was cut at 0.6 to visually improve curve’s resolution. The survival difference between CMR and CA was not significant. b Temporal dependence of diagnostic path assignment on cost progression. The cost medians with their corresponding 95 % confidence intervals are provided for CMR and CA. During late follow-up (≥2 years) due to sparse data pooled cost estimates (derived from pooled cost data of the years 2006–2008) had to be calculated and are depicted as dashed line. c Cost-effectiveness of CMR compared with CA. Median relative differences (see “Methods” for details) with their corresponding 95 % confidence intervals are provided. Pairwise comparison of CMR with CA revealed significant lower overall costs in CMR at similar clinical effectiveness
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Fig2: a Long-term survival of CMR and CA patients. Survival probability (depicted on the x-axis) was cut at 0.6 to visually improve curve’s resolution. The survival difference between CMR and CA was not significant. b Temporal dependence of diagnostic path assignment on cost progression. The cost medians with their corresponding 95 % confidence intervals are provided for CMR and CA. During late follow-up (≥2 years) due to sparse data pooled cost estimates (derived from pooled cost data of the years 2006–2008) had to be calculated and are depicted as dashed line. c Cost-effectiveness of CMR compared with CA. Median relative differences (see “Methods” for details) with their corresponding 95 % confidence intervals are provided. Pairwise comparison of CMR with CA revealed significant lower overall costs in CMR at similar clinical effectiveness

Mentions: CMR and CA groups differed in re-hospitalization pattern—in CMR patients predominant ambulatory follow-up was reflected by a larger number of visits to the outpatient department (CMR: 83 % vs. CA: 34 %, p = 0.001), whereas CA patients were more often hospitalized (CMR: 35 % vs. CA: 98 %, p = 0.001). Death occurred infrequently in both groups (CMR: 4 % vs. CA: 7 %, p = 0.149; Table 2). Similar survival was observed in the CMR and CA groups particularly within the first 4 years after study inclusion (p = 0.139; Fig. 2a), even after adjustment for revascularization by PCI (HR 1.49, 95 % CI 0.44–5.07, p = 0.524) or CABG (HR 0.52, 95 % CI 0.19–1.44, p = 0.209) (Supplement, Table S1).Table 2


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)

a Long-term survival of CMR and CA patients. Survival probability (depicted on the x-axis) was cut at 0.6 to visually improve curve’s resolution. The survival difference between CMR and CA was not significant. b Temporal dependence of diagnostic path assignment on cost progression. The cost medians with their corresponding 95 % confidence intervals are provided for CMR and CA. During late follow-up (≥2 years) due to sparse data pooled cost estimates (derived from pooled cost data of the years 2006–2008) had to be calculated and are depicted as dashed line. c Cost-effectiveness of CMR compared with CA. Median relative differences (see “Methods” for details) with their corresponding 95 % confidence intervals are provided. Pairwise comparison of CMR with CA revealed significant lower overall costs in CMR at similar clinical effectiveness
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig2: a Long-term survival of CMR and CA patients. Survival probability (depicted on the x-axis) was cut at 0.6 to visually improve curve’s resolution. The survival difference between CMR and CA was not significant. b Temporal dependence of diagnostic path assignment on cost progression. The cost medians with their corresponding 95 % confidence intervals are provided for CMR and CA. During late follow-up (≥2 years) due to sparse data pooled cost estimates (derived from pooled cost data of the years 2006–2008) had to be calculated and are depicted as dashed line. c Cost-effectiveness of CMR compared with CA. Median relative differences (see “Methods” for details) with their corresponding 95 % confidence intervals are provided. Pairwise comparison of CMR with CA revealed significant lower overall costs in CMR at similar clinical effectiveness
Mentions: CMR and CA groups differed in re-hospitalization pattern—in CMR patients predominant ambulatory follow-up was reflected by a larger number of visits to the outpatient department (CMR: 83 % vs. CA: 34 %, p = 0.001), whereas CA patients were more often hospitalized (CMR: 35 % vs. CA: 98 %, p = 0.001). Death occurred infrequently in both groups (CMR: 4 % vs. CA: 7 %, p = 0.149; Table 2). Similar survival was observed in the CMR and CA groups particularly within the first 4 years after study inclusion (p = 0.139; Fig. 2a), even after adjustment for revascularization by PCI (HR 1.49, 95 % CI 0.44–5.07, p = 0.524) or CABG (HR 0.52, 95 % CI 0.19–1.44, p = 0.209) (Supplement, Table S1).Table 2

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