Abstract 18808: Comparative Cost-Effectiveness of Computed Tomography Coronary Angiography Alone or in Combination With Stress Imaging for the Diagnosis of Coronary Artery Disease in Patients With Stable Angina. Results From the EVINCI Study
Introduction: The comparative diagnostic cost-effectiveness of computed tomography coronary angiography (CTCA) alone or in combination with stress imaging in patients with suspected coronary artery disease (CAD) is not fully known. To this aim we performed a health-economic analysis in the European EVINCI study population undergoing non invasive imaging prior to invasive coronary angiography (ICA).
Methods: Data collected in 475 patients submitted to CTCA, stress ECHO and/or SPECT because of stable symptoms and intermediate probability of CAD were analysed. Significant CAD was defined by the presence at ICA of at least one >70% stenosis of a major vessel or 30-70% stenosis with FFR < 0.8. Non invasive tests were interpreted by standard criteria and judged uncertain in case of poor imaging quality or inadequate stress (submaximal or no therapy withdrawal). Six diagnostic strategies were analysed including direct referral to ICA and using “no tests” as reference. The second non-invasive test in combined strategies was used if the first test was uncertain. ICA was included in case of final uncertain results. Costs were calculated using country-specific reimbursements and adjusted using purchase power parity. Effectiveness was defined by correct diagnosis. False positive or negatives were penalized adding a single or double cost of ICA. ICERs were obtained from per-patient data and 95% confidence limits were estimated by non-parametric bootstrap.
Results: Significant CAD at ICA was diagnosed in 140 (29.5%) patients. Results are reported in Table. CTCA alone or CTCA-guided strategies were less costly and more effective than “no tests” strategy. They were cost-effective as compared with direct referral to ICA and dominated other strategies.
Conclusions: CTCA alone or as first test in combination with stress imaging is cost-effective for the diagnosis of significant CAD in stable patients with intermediate pre-test probability of CAD and low prevalence of disease.
Author Disclosures: V. Lorenzoni: None. D. Neglia: None. S. Bellelli: None. A.J. Scholte: None. R. Sicari: None. J. Zamorano: None. M. Lombardi: None. P. Kaufmann: None. J. Knuuti: None. R. Underwood: None. G. Turchetti: None.
- © 2016 by American Heart Association, Inc.