Cardiac-CT and cardiac-MR cost-effectiveness: a literature review
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CARDIAC RADIOLOGY
Cardiac‑CT and cardiac‑MR cost‑effectiveness: a literature review Maurizio Centonze1 · Stephanie Steidler2 · Giulia Casagranda1 · Ugolino Alfonsi1 · Federica Spagnolli1 · Umberto Rozzanigo1 · Diego Palumbo2,3 · Riccardo Faletti4 · Francesco De Cobelli2,3 Received: 13 July 2020 / Accepted: 8 September 2020 © Italian Society of Medical Radiology 2020
Abstract Cardiovascular diseases are still among the first causes of death worldwide with a huge impact on healthcare systems. Within these conditions, the correct diagnosis of coronary artery disease with the most appropriate imaging-based evaluations is of utmost importance. The sustainability of the healthcare systems, considering the high economic burden of modern cardiac imaging equipments, makes cost-effective analysis an important tool, currently used for weighing different costs and health outcomes, when policy makers have to allocate funds and to prioritize interventions, getting the most out of their financial resources. This review aims at evaluating cost-effective analysis in the more recent literature, focused on the role of Calcium Score, coronary computed tomography angiography and cardiac magnetic resonance. Keywords Coronary computed tomography angiography (CCTA) · Calcium score (CS) · Cardiac magnetic resonance (CMR) · Cost-effectiveness analysis (CEA)
Introduction An ideal sustainable healthcare system delivers high quality care and improves public health without exhausting man-power and financial resources. Nowadays, we have to face an increased awareness on the costs related to healthcare systems in which the most frequently used tool for decision-making is evidence-based medicine (EBM). This perspective is often accepted reluctantly by physicians and may be applied with bias by healthcare professionals. It is therefore mandatory to shift this paradigm from what “works”—EBM—to what is actually needed to guarantee appropriate healthcare and improve patients’ lives. In this scenario, cardiovascular diseases (CVD) still comprise one of the predominant causes of death globally (near 18 million * Maurizio Centonze [email protected] 1
Department of Diagnostic Imaging, APSS of Trento, Trento, Italy
2
Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
3
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
4
Radiology Unit, Department of Surgical Science, University of Turin, Turin, Italy
worldwide) and contribute predominantly to a decrease in quality of life [1]. In the second-half of the last decade, the costs of CVD in the USA corresponded to $300 billion a year and in the European Union €210 billion a year [2]. These high expenditures are also linked to the high costs for diagnostic imaging equipment, in particular computed tomography and magnetic resonance. Between 1993 and 2002, cardiovascular imaging represented nearly 30% of the worldwide imaging and had risen more twice compared to non-cardiac-related imaging; in 2005
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