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)
    Pages (from-to)44-54
    Number of pages11
    JournalJournal of Cardiovascular Computed Tomography
    Volume14
    Issue number1
    DOIs
    StatePublished - Jan 1 2020

    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

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  • Cite this

    Goehler, A., Mayrhofer, T., Pursnani, A., Ferencik, M., Lumish, H. S., Barth, C., Karády, J., Chow, B., Truong, Q. A., Udelson, J. E., Fleg, J. L., Nagurney, J. T., Gazelle, G. S., & Hoffmann, U. (2020). Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome. Journal of Cardiovascular Computed Tomography, 14(1), 44-54. https://doi.org/10.1016/j.jcct.2019.06.008