Abstract 15167: Coronary Computed Tomography Reduces Downstream Resource Utilization and is Cost-Effective Test Strategy for Coronary Artery Disease Assessment-A Systematic Review

Abstract

Background: Cardiac CT angiography (CCTA) has shown superior diagnostic accuracy. We performed systematic search of literature on the cost effectiveness and downstream test utilization associated with the use of CCTA.

Methods: We searched literature for randomized controlled trials or prospective or retrospective non-randomized comparative studies or case series, decision analytic models and technology reports in which some or all of the patients underwent CCTA and looking at cost effectiveness, comparative effectiveness and downstream test utilization associated with use of CCTA.

Results: We found 42 studies matching our criteria. Decision analytic models showed that CCTA either alone or in combination with stress testing is a cost effective strategy for initial evaluation of patients with coronary artery disease (CAD) prevalence of 10% to 50% in both near-term and long-term diagnostic periods. For CAD prevalence ≤10%, SPECT alone’ is the most effective strategy However, use of SPECT is associated with higher incremental cost effective ratios ($82,300 vs. $17,000 for SPECT vs. CCTA). CCTA use is associated with lowered healthcare cost (26.5% lower cost), less likely to undergo coronary revascularization (odds ratio 0.76, 95% CI: 0.75, 0.77; p<0.001) and no significant difference for adverse events compared with stress MPI. Downstream testing is less frequent with CCTA use compared with stress testing (21% vs. 32%, p=0.003). Another study reported that use of CCTA is associated with increase in coronary revascularization rates (11.5%) and higher total healthcare spending ($4200 [$3193 to $5267]; P<0.001). Use of CCTA is associated with higher rates of discharge from emergency department (48.15% vs. 17.55%,p<0.05), shorter length of stay (median 13.3 vs. 26.8 hours, p<0.05) and 55% reduction in time to diagnosis, without increase in cost of care and associated with safe exclusion of acute coronary syndrome in low risk acute chest pain patients.

Conclusion: CCTA is an effective diagnostic tool and associated with less downstream testing for diagnosis of stable chest pain in low to intermediate risk patients whereas for low risk acute chest pain patients, use of CCTA is associated with expedited patient management and safe exclusion of ACS.