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

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Abstract

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)
JournalJACC. Cardiovascular imaging
DOIs
StateE-pub ahead of print - May 8 2020

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Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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    Ge, Y., Pandya, A., Steel, K., Bingham, S., Jerosch-Herold, M., Chen, Y-Y., Mikolich, J. R., Arai, A. E., Bandettini, W. P., Patel, A. R., Farzaneh-Far, A., Heitner, J. F., Shenoy, C., Leung, S. W., Gonzalez, J. A., Shah, D. J., Raman, S. V., Ferrari, V. A., Schulz-Menger, J., ... Kwong, R. Y. (2020). Cost-Effectiveness Analysis of Stress Cardiovascular Magnetic Resonance Imaging for Stable Chest Pain Syndromes. JACC. Cardiovascular imaging. https://doi.org/10.1016/j.jcmg.2020.02.029