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Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study.

Authors :
Lorenzoni, Valentina
Bellelli, Stefania
Caselli, Chiara
Knuuti, Juhani
Underwood, Stephen Richard
Neglia, Danilo
Turchetti, Giuseppe
For the EVINCI Investigators
Pietila, Mikko
Mäki, Maija
Teresinska, Anna
Aguadé-Bruix, Santiago
Pizzi, Maria Nazarena
Todiere, Giancarlo
Gimelli, Alessia
Lombardi, Massimo
Puzzuoli, Stefano
Mangione, Maurizio
Marcheschi, Paolo
Schroeder, Stephen
Source :
European Journal of Health Economics; Dec2019, Vol. 20 Issue 9, p1437-1449, 13p
Publication Year :
2019

Abstract

<bold>Aim: </bold>This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population of patients from the Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease (EVINCI) study.<bold>Methods and Results: </bold>Cost-effectiveness analysis was performed in 350 patients (209 males, mean age 59 ± 9 years) with symptoms of suspected stable CAD undergoing computed tomography coronary angiography (CTCA) and at least one cardiac imaging stress-test prior to invasive coronary angiography (ICA) and in whom imaging exams were analysed at dedicated core laboratories. Stand-alone stress-tests or combined non-invasive strategies, when the first exam was uncertain, were compared. The diagnostic end-point was obstructive CAD defined as > 50% stenosis at quantitative ICA in the left main or at least one major coronary vessel. Effectiveness was defined as the percentage of correct diagnosis (cd) and costs were calculated using country-specific reimbursements. Incremental cost-effectiveness ratios (ICERs) were obtained using per-patient data and considering "no-imaging" as reference. The overall prevalence of obstructive CAD was 28%. Strategies combining CTCA followed by stress ECHO, SPECT, PET, or stress CMR followed by CTCA, were all cost-effective. ICERs values indicated cost saving from - 969€/cd for CMR-CTCA to - 1490€/cd for CTCA-PET, - 3092€/cd for CTCA-SPECT and - 3776€/cd for CTCA-ECHO. Similarly when considering early revascularization as effectiveness measure.<bold>Conclusion: </bold>In patients with suspected stable CAD and low prevalence of disease, combined non-invasive strategies with CTCA and stress-imaging are cost-effective as gatekeepers to ICA and to select candidates for early revascularization. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
16187598
Volume :
20
Issue :
9
Database :
Complementary Index
Journal :
European Journal of Health Economics
Publication Type :
Academic Journal
Accession number :
139694399
Full Text :
https://doi.org/10.1007/s10198-019-01096-5