Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome

Alexander Goehler, Thomas Mayrhofer, Amit Pursnani, Maros Ferencik, Heidi S. Lumish, Cordula Barth, Júlia Karády, Benjamin Chow, Quynh A. Truong, James E. Udelson, Jerome L. Fleg, John T. Nagurney, G. Scott Gazelle, Udo Hoffmann

    Research output: Contribution to journalArticle

    Abstract

    Background: Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Methods: Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Results: Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10–1.17; 10-year: 5.06% vs. 5.21–5.36%; respectively). Conclusion: Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.

    Original languageEnglish (US)
    JournalJournal of Cardiovascular Computed Tomography
    DOIs
    StatePublished - Jan 1 2019

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    Acute Coronary Syndrome
    Coronary Angiography
    Health Care Costs
    Cost-Benefit Analysis
    Costs and Cost Analysis
    Quality-Adjusted Life Years
    Standard of Care
    Mortality
    Hospital Emergency Service
    Guidelines
    Morbidity
    Insurance Benefits
    Computed Tomography Angiography
    Routine Diagnostic Tests
    Outpatients
    Quality of Life

    Keywords

    • Acute chest pain
    • Acute coronary syndrome
    • Coronary CTA
    • Cost-effectiveness analysis
    • Markov microsimulation model

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

    Cite this

    Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome. / Goehler, Alexander; Mayrhofer, Thomas; Pursnani, Amit; Ferencik, Maros; Lumish, Heidi S.; Barth, Cordula; Karády, Júlia; Chow, Benjamin; Truong, Quynh A.; Udelson, James E.; Fleg, Jerome L.; Nagurney, John T.; Gazelle, G. Scott; Hoffmann, Udo.

    In: Journal of Cardiovascular Computed Tomography, 01.01.2019.

    Research output: Contribution to journalArticle

    Goehler, A, Mayrhofer, T, Pursnani, A, Ferencik, M, Lumish, HS, Barth, C, Karády, J, Chow, B, Truong, QA, Udelson, JE, Fleg, JL, Nagurney, JT, Gazelle, GS & Hoffmann, U 2019, 'Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome', Journal of Cardiovascular Computed Tomography. https://doi.org/10.1016/j.jcct.2019.06.008
    Goehler, Alexander ; Mayrhofer, Thomas ; Pursnani, Amit ; Ferencik, Maros ; Lumish, Heidi S. ; Barth, Cordula ; Karády, Júlia ; Chow, Benjamin ; Truong, Quynh A. ; Udelson, James E. ; Fleg, Jerome L. ; Nagurney, John T. ; Gazelle, G. Scott ; Hoffmann, Udo. / Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome. In: Journal of Cardiovascular Computed Tomography. 2019.
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    abstract = "Background: Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Methods: Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Results: Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2{\%} vs. 2.6{\%}-3.7{\%}) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04{\%} vs. 1.10–1.17; 10-year: 5.06{\%} vs. 5.21–5.36{\%}; respectively). Conclusion: Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.",
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    author = "Alexander Goehler and Thomas Mayrhofer and Amit Pursnani and Maros Ferencik and Lumish, {Heidi S.} and Cordula Barth and J{\'u}lia Kar{\'a}dy and Benjamin Chow and Truong, {Quynh A.} and Udelson, {James E.} and Fleg, {Jerome L.} and Nagurney, {John T.} and Gazelle, {G. Scott} and Udo Hoffmann",
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    T1 - Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome

    AU - Goehler, Alexander

    AU - Mayrhofer, Thomas

    AU - Pursnani, Amit

    AU - Ferencik, Maros

    AU - Lumish, Heidi S.

    AU - Barth, Cordula

    AU - Karády, Júlia

    AU - Chow, Benjamin

    AU - Truong, Quynh A.

    AU - Udelson, James E.

    AU - Fleg, Jerome L.

    AU - Nagurney, John T.

    AU - Gazelle, G. Scott

    AU - Hoffmann, Udo

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Methods: Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Results: Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10–1.17; 10-year: 5.06% vs. 5.21–5.36%; respectively). Conclusion: Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.

    AB - Background: Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime. Methods: Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model. Results: Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10–1.17; 10-year: 5.06% vs. 5.21–5.36%; respectively). Conclusion: Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.

    KW - Acute chest pain

    KW - Acute coronary syndrome

    KW - Coronary CTA

    KW - Cost-effectiveness analysis

    KW - Markov microsimulation model

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