Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients
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COMPUTED TOMOGRAPHY
Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients S. H. Kim 1 & J. Rübenthaler 1 & D. Nörenberg 2 & T. Huber 2 & W. G. Kunz 1 & W. H. Sommer 1 & S. O. Schoenberg 2 & S. Janssen 2 & D. Overhoff 2 & M. F. Froelich 2 Received: 23 April 2020 / Revised: 16 June 2020 / Accepted: 18 August 2020 # The Author(s) 2020
Abstract Objectives The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation. Methods A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs. Cost-effectiveness was assessed based on a costeffectiveness threshold of $100,000 per QALY. Results In the base-case scenario with willingness to pay of $100,000 per QALY, CTA resulted in total costs of $47,013.87 and an expected effectiveness of 6.84 QALYs, whereas CTP resulted in total costs of $46,758.83 with 6.93 QALYs. CTA + CTP reached costs of $47,455.63 with 6.85 QALYs. Therefore, strategies CTA and CTA + CTP were dominated by CTP in the basecase scenario. Deterministic sensitivity analysis demonstrated robustness of the model to variations of diagnostic efficacy parameters and costs in a broad range. CTP was cost-effective in the majority of iterations in the probabilistic sensitivity analysis as compared with CTA. Conclusions CTP is cost-effective for the detection of obstructive CAD or ISR in patients with previous stenting and therefore should be considered a feasible approach in daily clinical practice. Key Points • CTP provides added diagnostic value in patients with previous coronary stents. • CTP is a cost-effective method for the detection of obstructive CAD or ISR in patients with previous stenting. Keywords Cost-benefit analysis . Tomography, X-ray computed . Computed tomography angiography . Coronary artery disease . Stents
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07202-z) contains supplementary material, which is available to authorized users. * M. F. Froelich [email protected] 1
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
2
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Abbreviations CAD Coronary artery disease CTA Coronary computed tomography angiography CTP Adenosine-induced stress myocardial computed tomograp
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