Back to Search
Start Over
Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome.
- Source :
- Journal of Cardiovascular Computed Tomography; Jan2020, Vol. 14 Issue 1, p44-54, 11p
- Publication Year :
- 2020
-
Abstract
- Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10–1.17; 10-year: 5.06% vs. 5.21–5.36%; respectively). Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 19345925
- Volume :
- 14
- Issue :
- 1
- Database :
- Supplemental Index
- Journal :
- Journal of Cardiovascular Computed Tomography
- Publication Type :
- Academic Journal
- Accession number :
- 142229480
- Full Text :
- https://doi.org/10.1016/j.jcct.2019.06.008