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

Yin Ge, Ankur Pandya, Kevin Steel, Scott Bingham, Michael Jerosch-Herold, Yi-Yun Chen, J Ronald Mikolich, Andrew E Arai, W Patricia Bandettini, Amit R Patel, Afshin Farzaneh-Far, John F Heitner, Chetan Shenoy, Steve W Leung, Jorge A Gonzalez, Dipan J Shah, Subha V Raman, Victor A Ferrari, Jeanette Schulz-Menger, Rory HachamovitchMatthias Stuber, Orlando P Simonetti, Raymond Y Kwong

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1505-1517
Number of pages13
JournalJACC. Cardiovascular imaging
Issue number7
Early online dateMay 8 2020
StatePublished - Jul 2020

Bibliographical note

Funding Information:
The SPINS registry was funded by the Society for Cardiovascular Magnetic Resonance, using a research grant jointly sponsored by Siemens Healthineers and Bayer. These sponsors to the Society for Cardiovascular Magnetic Resonance provided financial support for the study but did not play a role in study design, data collection, analysis, interpretation, or manuscript drafting. Dr. Arai has research agreements with Siemens, Bayer, and Circle Cardiovascular Imaging. Dr. Bandettini is the principal investigator of one of the Bayer-sponsored GadaCAD2 (Gadavist-Enhanced Cardiac Magnetic Resonance Imaging to Detect Coronary Artery Disease) sites. Dr. Patel has received a research grant from and served on the Speakers Bureau of Astellas. Drs. Raman and Simonetti both receive institutional research support from Siemens. Dr. Schulz-Menger has research agreements with Siemens; and serves on the Advisory Board of Bayer. Dr. Stuber has received nonmonetary research support form Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2020 American College of Cardiology Foundation

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Multicenter Study


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