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  • Title: 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.
    Author: Kreisz FP, Merlin T, Moss J, Atherton J, Hiller JE, Gericke CA.
    Journal: Heart Lung Circ; 2009 Jun; 18(3):200-7. PubMed ID: 19250870.
    Abstract:
    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.
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