Abstract | AIMS: To compare the cost-effectiveness of coronary computed tomography angiography (CCTA) vs. myocardial single photon emission computed tomography (SPECT) in patients with stable intermediate risk chest pain. METHODS AND RESULTS: Non-acute patients with 10-90% pre-test probability of coronary artery disease from three high-volume centres in Korea (n = 965) were randomized 1:1 to CCTA or myocardial SPECT as the initial non-invasive imaging test. Medical costs after randomization, the downstream outcome, including all-cause death, acute coronary syndrome, cerebrovascular accident, repeat revascularization, stent thrombosis, and significant bleeding following the initial test and the quality-adjusted life-years (QALYs) gained by the EuroQoL-5D questionnaire was compared between the two groups. In all, 903 patients underwent the initially randomized study (n = 460 for CCTA, 443 for SPECT). In all, 65 patients underwent invasive coronary angiography (ICA) in the CCTA and 85 in the SPECT group, of which 4 in the CCTA and 30 in the SPECT group demonstrated no stenosis on ICA [6.2% (4/65) vs. 35.3% (30/85), P-value < 0.001]. There was no difference in the downstream clinical events. QALYs gained was higher in the SPECT group (0.938 vs. 0.955, P-value = 0.039) but below the threshold of minimal clinically important difference of 0.08. Overall cost per patient was lower in the CCTA group (USD 4514 vs. 5208, P-value = 0.043), the tendency of which was non-significantly opposite in patients with 60-90% pre-test probability (USD 5807 vs. 5659, P-value = 0.845). CONCLUSION: CCTA is associated with fewer subsequent ICA with no difference in downstream outcome. CCTA may be more cost-effective than SPECT in Korean patients with stable, intermediate risk chest pain.
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Authors | Seung-Pyo Lee, Jae-Kyung Seo, In-Chang Hwang, Jun-Bean Park, Eun-Ah Park, Whal Lee, Jin-Chul Paeng, Hyun-Ju Lee, Yeonyee E Yoon, Hack-Lyoung Kim, Eunbee Koh, Insun Choi, Ji Eun Choi, Yong-Jin Kim |
Journal | European heart journal. Cardiovascular Imaging
(Eur Heart J Cardiovasc Imaging)
Vol. 20
Issue 4
Pg. 417-425
(04 01 2019)
ISSN: 2047-2412 [Electronic] England |
PMID | 30052964
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Copyright | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: [email protected]. |
Topics |
- Angina, Stable
(diagnostic imaging)
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
(economics)
- Chest Pain
(diagnostic imaging, etiology)
- Computed Tomography Angiography
(economics)
- Coronary Angiography
(economics)
- Coronary Artery Disease
(diagnostic imaging)
- Cost-Benefit Analysis
- Humans
- Myocardial Perfusion Imaging
(economics)
- Risk
- Tomography, Emission-Computed, Single-Photon
(economics)
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