Abstract 17340: Health and Economic Outcomes after Detection of Incidental Pulmonary Nodules during Cardiac CT Angiography in Patients with suspected Coronary Artery Disease

Abstract

BACKGROUND: Coronary CTA (CCTA) is increasingly used to evaluate stable symptomatic patients with suspicion for coronary artery disease (CAD). We sought to determine health benefits, costs and cost-effectiveness of follow-up of pulmonary nodules (PN) incidentally detected during CCTA.

METHODS: Our analyses included stable symptomatic patients (n=591) without a history of CAD, lung cancer (LC) or previously detected PN who were referred for assessment of CAD between 2005 and 2008. Clinical reports were reviewed for PN, demographics, smoking history, and CAD. The data was used to inform the MGH-LCPM, a validated computer simulation model of LC. The model was populated with a similar cohort of patients (n>275,000,by sampling with replacement) and mortality, resource utilization (Fleischer guidelines) and costs were estimated for follow-up (FU) vs no FU and used to determine cost-effectiveness.

RESULTS: Patients with incidental PN requiring FU had a mean age of 59 years, 66% were men, 59% smokers, and 21% had obstructive CAD. A comparison of mortality, resource utilization, and costs is provided in table 1. Follow-up of these patients for PN resulted in a minimal decrease in mortality from LC but overall mortality was dominated by CAD and other causes. The largest difference in resource utilization was seen in the number of CT’s. Costs were higher for imaging, staging and treatment. Quality-adjusted life expectancy was nearly equal between the two strategies (17.21 years no FU vs. 17.22 years FU) resulting in additional costs of $136,480 per quality adjusted life year gained.

CONCLUSION: In stable symptomatic patients undergoing CCTA, prevalence of PN is substantial and their follow-up costly, while overall mortality is primarily dominated by CAD and other, non-LC causes. As a result, FU of incidentally detected PNs less cost-effective compared to other interventions.