Abstract 314: Cost-Effectiveness of Coronary Computed Tomography Angiography versus Myocardial Perfusion SPECT Imaging for the Evaluation of Patients With Chest Pain and No Known Coronary Artery Disease
Purpose: To evaluate the cost-effectiveness of diagnostic strategies for individuals with chest pain without known coronary artery disease (CAD) in the ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) eligible population.
Materials and Methods: We performed a decision analysis comparing: CCTA followed by invasive coronary angiography (ICA) for positive/equivocal (CCTA-only), CCTA followed by ICA for positive and MPS for equivocal (CCTA-first); MPS followed by ICA for positive/equivocal (MPS-only); MPS followed by ICA for positive and CCTA for equivocal (MPS-first); and ICA. Analyses were conducted from the payer perspective for a near-term diagnostic period and a long-term lifetime period.. The base case was a 55-year old man with 30% risk of obstructive CAD.
Results: Using the base case for near-term cost per correct diagnosis, a CCTA-first strategy was the least expensive, followed by CCTA-only (incremental cost-effectiveness ratio [ICER]= $17,516). For long-term cost effectiveness, a CCTA-only strategy demonstrated a favorable ICER of $20,429 per quality-adjusted life year (QALY) relative to the least expensive CCTA-first strategy. Both MPS-only and MPS-first strategies were more costly and less effective than either CCTA strategy. Long-term results were sensitive to CCTA sensitivity, MPS sensitivity and CAD prevalence. CCTA-first and CCTA-only strategies remained dominant up to a baseline CCTA test cost of $1,100 and 80% CAD prevalence.
Conclusion: Using a $20,000 threshold for cost per correct diagnosis and $50,000 per QALY, a CCTA-only approach is the most cost-effective diagnostic strategy for evaluation of stable chest pain patients without known CAD with intermediate CAD prevalence.