The Pre-Test Risk Stratified Cost-Effectiveness of 64-Slice Computed Tomography Coronary Angiography in the Detection of Significant Obstructive Coronary Artery Disease in Patients Otherwise Referred to Invasive Coronary Angiography

Kreisz, Florian P.; Merlin, Tracy; Moss, John; Atherton, John; Hiller, Janet E.; Gericke, Christian A.

doi:10.1016/j.hlc.2008.10.013

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Volume 18, Issue 3 , Pages 200-207, June 2009

The Pre-Test Risk Stratified Cost-Effectiveness of 64-Slice Computed Tomography Coronary Angiography in the Detection of Significant Obstructive Coronary Artery Disease in Patients Otherwise Referred to Invasive Coronary Angiography

Florian P. Kreisz, MSc
- Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
Tracy Merlin, BA (Hons), MPH
- Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
- Corresponding author at: Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, Mail Drop DX650 545, School of Population Health & Clinical Practice, The University of Adelaide, Adelaide, SA 5005, Australia. Tel.: +61 8 8303 3575; fax: +61 8 8303 6899.
John Moss, MBBS, PCHSE
- Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
John Atherton, PhD, FRACP, FCSANZ
- The Department of Cardiology, Royal Brisbane and Women's Hospital; Department of Medicine, The University of Queensland, Brisbane, Australia
Janet E. Hiller, MPH, PhD
- Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
Christian A. Gericke, MD, FACP, FAFPHM
- Adelaide Health Technology Assessment (AHTA), Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia

Received 8 August 2008; received in revised form 21 October 2008; accepted 27 October 2008.

Background

This study evaluates the cost-effectiveness of 64-slice computed tomography coronary angiography (CTCA) as an alternative to invasive diagnostic coronary angiography (CA) in an elective outpatient setting for patients otherwise referred to invasive diagnostic coronary angiography.

Methods

Taking the perspective of the Australian health system we used a decision analytic model to integrate data on test accuracy along with complication rates, health state preference weights and health care costs. The analysis is pre-test risk stratified based on Bayes’ theorem of conditional probability. Incremental cost-effectiveness ratios (ICER) are the study endpoints expressed as incremental costs per quality adjusted life year (QALY) gained.

Results

The results indicate that CTCA is a cost-saving strategy offering a higher health related quality of life up to approximately 65% pre-test risk of coronary artery disease (CAD). Above that threshold the model predicts a cost-utility trade-off with every gain in health related quality of life through the use of CTCA as a rule-out test being associated with additional costs when compared to invasive diagnostic CA.

Conclusion

This health economic analysis predicts computed tomography coronary angiography to be a cost-effective rule-out strategy in symptomatic patients at low to intermediate risk of significant obstructive coronary artery disease otherwise referred to invasive diagnostic CA.

Keywords: Cost-effectiveness, Computed tomography coronary angiography, Coronary artery disease