Abstract 18094: Cost-effectiveness of Cardiac Magnetic Resonance Imaging Used in Suspected Coronary Ischemia - A Post-hoc Analysis of a Natural Experiment

Abstract

BACKGROUND: Stress cardiac magnetic resonance imaging (SCMR) was not established as a test for coronary ischemia in 2003. Thus SCMR was an optional step in the decision on coronary angiography (CA). Reimbursement and cost-effectiveness of SCMR is still an issue in Germany.

METHODS: The study cohort of this “natural experiment” comprises 924 patients with suspected coronary artery disease (40% female, mean age 63 ± 11 years) presenting at our institution during 2003-2004. A group of 270 patients with SCMR guided CA (CMRCA) was compared to a matched control group with CA indicated by standard evaluation (SECA, N=654). Effectiveness was assessed in terms of death, revascularization and hospitalization. Individual micro cost data were available from calculations for the federal InEK/G-DRG database.

RESULTS: Cost data were available for 67 CMRCA (median 3387 €, mean 4702€ ± 3870 €) and 439 SECA (median 4864 €, mean 12638 € ± 43804 €) patients. Incremental cost-effectiveness ratio was calculated as 822 € per survival assuming 750 € expenditure per SCMR procedure. Sensitivity analysis demonstrated that at least 750 € are saved by CMRCA. PCI, CABG, death and number of hospital admissions were significantly less frequent in the CMRCA group (1%, 1%, 6% and 35%) than in the SECA group (34%, 20%, 11% and 97%). Survival was significantly better in the CMRCA group (log rank p<0.006).

CONCLUSION: CMRCA was more effective in terms of death and hospitalization. It is also cost-effective in competition with SECA even if a reimbursement of 750€ for SCMR is calculated.