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. and Gericke, Christian A. (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. Heart and Lung Circulation, 18 3: 200-207. doi:10.1016/j.hlc.2008.10.013


Author Kreisz, Florian P.
Merlin, Tracy
Moss, John
Atherton, John
Hiller, Janet E.
Gericke, Christian A.
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
Journal name Heart and Lung Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2009-06-01
Sub-type Article (original research)
DOI 10.1016/j.hlc.2008.10.013
Open Access Status
Volume 18
Issue 3
Start page 200
End page 207
Total pages 8
Place of publication London, United Kingdom
Publisher Elsevier
Language eng
Subject 1102 Cardiovascular Medicine and Haematology
Formatted 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.
Keyword Cost-effectiveness
Computed tomography coronary angiography
Coronary artery disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 20 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 03 Sep 2009, 18:00:21 EST by Mr Andrew Martlew on behalf of Faculty Of Health Sciences