Introduction
Methods
Search strategy of existing literature and data extraction
Development of the CMR cost effectiveness calculator (meta-model)
Results
Attribute | # of studies | % of studies (%) | Study citations |
---|---|---|---|
Setting | |||
US setting | 5 | 33 | |
European setting (including the UK) | 11 | 73 | |
Other setting | 2 | 13 | |
Comparators included | |||
No imaging | 2 | 13 | |
Stress echocardiography | 4 | 27 | |
Stress electrocardiography | 4 | 27 | |
SPECT | 11 | 73 | |
CCTA | 5 | 33 | |
Immediate coronary angiography | 10 | 67 | |
Main conclusion on CMR value | |||
CMR cost-effective | 10 | 67 | |
CMR not cost-effective | 2 | 13 | |
Unclear cost-effectiveness | 3 | 20 | |
Key drivers of cost-effectiveness results | |||
Underlying CAD prevalence | 9 | 60 | |
Test costs | 4 | 27 | |
Perspective taken | |||
Societal | 1 | 8 | Genders et al. [20] |
Healthcare system or payer | 10 | 67 | |
Hospital | 1 | 7 | Stojanovic et al. [29] |
Not clearly stated | 4 | 27 | |
Model time horizon | |||
Lifetime | 7 | 47 | |
10–30 years | 2 | 13 | |
3–10 years | 1 | 7 | Thom et al. [30] |
< 3 years | 4 | 27 | |
Not stated | 1 | 7 | Moschetti et al. [24] |
Summary of methods used for CMR cost-effectiveness studies
Summary of results of CMR cost-effectiveness studies
CMR cost effectiveness calculator (meta-model) results
Strategy | Costs | QALYs | ICER |
---|---|---|---|
Published Ge et al. [13] results | |||
No imaging | $16,936 | 12.721 | Reference |
CMR | $19,273 | 12.765 | $52,000/QALY |
CCTA | $19,886 | 12.765 | Dominated by CMR |
No imaging | $19,223 | 12.160 | Reference |
CMR | $21,962 | 12.204 | $63,000/QALY |
CCTA | $22,578 | 12.203 | Dominated by CMR |
Published Genders et al. [20] results for men | |||
No imaging | $6827 | 11.062 | Reference |
CCTA | $13,177 | 11.840 | $29,000/QALY |
CMR | $14,172 | 11.840 | Dominated by CCTA |
Published Genders et al. [20] results for women | |||
No imaging | $7506 | 12.110 | Reference |
CCTA | $14,109 | 12.340 | $29,000/QALY |
CMR | $15,198 | 12.330 | Dominated by CCTA |
No imaging | $12,549 | 12.844 | Reference |
CCTA | $14,487 | 12.889 | $42,000/QALY |
CMR | $14,289 | 12.884 | Dominated by CCTA |
Meta-model with selected Genders et al. [20] inputs except Ge et al. sensitivity/specificityC | |||
No imaging | $12,549 | 12.844 | Reference |
CMR | $13,997 | 12.885 | $34,000/QALY |
CCTA | $14,823 | 12.885 | Dominated by CMR |
Discussion
-
CMR-based diagnostic strategies produced health at reasonable value compared to setting-specific cost-effectiveness thresholds.
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When CMR is not available, CCTA represents a cost-effective alternative compared to a no imaging strategy or immediate ICA strategy, which is consistent with current recommendations of major international cardiac societies [39].