Cost-minimization analysis of three decision strategies for cardiac revascularization: Results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry

Karine Moschetti, Steffen E. Petersen, Guenter Pilz, Raymond Y. Kwong, Jean Blaise Wasserfallen, Massimo Lombardi, Grigorios Korosoglou, Albert C. Van Rossum, Oliver Bruder, Heiko Mahrholdt, Juerg Schwitter

Research output: Contribution to journalArticle

Abstract

Background: Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. Methods: In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50 % stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50 % stenoses. To calculate the proportion of patients with ≥50 % stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. Results: Revascularizations were performed in 6.2 %, 4.5 %, and 12.9 % of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3 %, 1.1 %, and 1.5 %, respectively. The CMR + CXA-strategy reduced costs by 14 %, 34 %, 27 %, and 24 % in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59 %, 52 %, 61 % and 71 %, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3 %), intermediate in the US and Swiss (11.6 % and 12.8 %, respectively), and remained substantial in the UK (18.9 %) systems. Sensitivity analyses proved the robustness of results. Conclusions: A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.

Original languageEnglish
Article number22
JournalJournal of Cardiovascular Magnetic Resonance
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 11 2016

Fingerprint

Coronary Angiography
Registries
Coronary Artery Disease
Magnetic Resonance Spectroscopy
X-Rays
Costs and Cost Analysis
Pathologic Constriction
Cost Savings
Chest Pain
Infarction
Cost-Benefit Analysis
Cause of Death
Ischemia
Public Health
Perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Family Practice

Cite this

Cost-minimization analysis of three decision strategies for cardiac revascularization : Results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry. / Moschetti, Karine; Petersen, Steffen E.; Pilz, Guenter; Kwong, Raymond Y.; Wasserfallen, Jean Blaise; Lombardi, Massimo; Korosoglou, Grigorios; Van Rossum, Albert C.; Bruder, Oliver; Mahrholdt, Heiko; Schwitter, Juerg.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 18, No. 1, 22, 11.01.2016.

Research output: Contribution to journalArticle

Moschetti, Karine ; Petersen, Steffen E. ; Pilz, Guenter ; Kwong, Raymond Y. ; Wasserfallen, Jean Blaise ; Lombardi, Massimo ; Korosoglou, Grigorios ; Van Rossum, Albert C. ; Bruder, Oliver ; Mahrholdt, Heiko ; Schwitter, Juerg. / Cost-minimization analysis of three decision strategies for cardiac revascularization : Results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry. In: Journal of Cardiovascular Magnetic Resonance. 2016 ; Vol. 18, No. 1.
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abstract = "Background: Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. Methods: In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50 {\%} stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50 {\%} stenoses. To calculate the proportion of patients with ≥50 {\%} stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. Results: Revascularizations were performed in 6.2 {\%}, 4.5 {\%}, and 12.9 {\%} of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3 {\%}, 1.1 {\%}, and 1.5 {\%}, respectively. The CMR + CXA-strategy reduced costs by 14 {\%}, 34 {\%}, 27 {\%}, and 24 {\%} in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59 {\%}, 52 {\%}, 61 {\%} and 71 {\%}, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3 {\%}), intermediate in the US and Swiss (11.6 {\%} and 12.8 {\%}, respectively), and remained substantial in the UK (18.9 {\%}) systems. Sensitivity analyses proved the robustness of results. Conclusions: A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.",
author = "Karine Moschetti and Petersen, {Steffen E.} and Guenter Pilz and Kwong, {Raymond Y.} and Wasserfallen, {Jean Blaise} and Massimo Lombardi and Grigorios Korosoglou and {Van Rossum}, {Albert C.} and Oliver Bruder and Heiko Mahrholdt and Juerg Schwitter",
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T1 - Cost-minimization analysis of three decision strategies for cardiac revascularization

T2 - Results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry

AU - Moschetti, Karine

AU - Petersen, Steffen E.

AU - Pilz, Guenter

AU - Kwong, Raymond Y.

AU - Wasserfallen, Jean Blaise

AU - Lombardi, Massimo

AU - Korosoglou, Grigorios

AU - Van Rossum, Albert C.

AU - Bruder, Oliver

AU - Mahrholdt, Heiko

AU - Schwitter, Juerg

PY - 2016/1/11

Y1 - 2016/1/11

N2 - Background: Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. Methods: In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50 % stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50 % stenoses. To calculate the proportion of patients with ≥50 % stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. Results: Revascularizations were performed in 6.2 %, 4.5 %, and 12.9 % of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3 %, 1.1 %, and 1.5 %, respectively. The CMR + CXA-strategy reduced costs by 14 %, 34 %, 27 %, and 24 % in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59 %, 52 %, 61 % and 71 %, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3 %), intermediate in the US and Swiss (11.6 % and 12.8 %, respectively), and remained substantial in the UK (18.9 %) systems. Sensitivity analyses proved the robustness of results. Conclusions: A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.

AB - Background: Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. Methods: In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50 % stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50 % stenoses. To calculate the proportion of patients with ≥50 % stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. Results: Revascularizations were performed in 6.2 %, 4.5 %, and 12.9 % of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3 %, 1.1 %, and 1.5 %, respectively. The CMR + CXA-strategy reduced costs by 14 %, 34 %, 27 %, and 24 % in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59 %, 52 %, 61 % and 71 %, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3 %), intermediate in the US and Swiss (11.6 % and 12.8 %, respectively), and remained substantial in the UK (18.9 %) systems. Sensitivity analyses proved the robustness of results. Conclusions: A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.

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