Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study
- Simon Walker1,
- François Girardin1,2,3,
- Claire McKenna1,
- Stephen G Ball4,
- Jane Nixon5,
- Sven Plein4,
- John P Greenwood4,
- Mark Sculpher1
- 1Centre for Health Economics, University of York, York, UK
- 2Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- 3Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
- 4Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- 5Clinical Trials Research Unit, University of Leeds, Leeds, UK
- Correspondence to Simon Walker, Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK;
- Received 10 January 2013
- Revised 15 March 2013
- Accepted 17 March 2013
- Published Online First 16 April 2013
Objective To evaluate the cost-effectiveness of diagnostic strategies for coronary heart disease (CHD) derived from the CE-MARC study.
Design Cost-effectiveness analysis using a decision analytic model to compare eight strategies for the diagnosis of CHD.
Setting Secondary care out-patients (Cardiology Department).
Patients Patients referred to cardiologists for the further evaluation of symptoms thought to be angina pectoris.
Interventions Eight different strategies were considered, including different combinations of exercise treadmill testing (ETT), single-photon emission CT (SPECT), cardiovascular magnetic resonance (CMR) and coronary angiography (CA).
Main outcome measures Costs expressed as UK sterling in 2010–2011 prices and health outcomes in quality-adjusted life-years (QALYs). The time horizon was 50 years.
Results Based on the characteristics of patients in the CE-MARC study, only two strategies appear potentially cost-effective for diagnosis of CHD, both including CMR. The choice is between two strategies: one in which CMR follows a positive or inconclusive ETT, followed by CA if CMR is positive or inconclusive (Strategy 3 in the model); and the other where CMR is followed by CA if CMR is positive or inconclusive (Strategy 5 in the model). The more cost-effective of these two rests on the threshold cost per QALY gained below which health systems define an intervention as cost-effective. Strategy 3 appears cost-effective at the lower end of the threshold range used in the UK (£20 000 per QALY gained), while Strategy 5 appears cost-effective at the higher end of the threshold range (£30 000 per QALY). The results are robust to various sources of uncertainty although prior likelihood of CHD requiring revascularisation and the rate at which false negative patients are eventually appropriately identified do impact upon the results.
Conclusions The CE-MARC study showed that CMR had superior diagnostic accuracy to SPECT and concluded that CMR should be more widely used in the investigation of patients with CHD. The economic evaluation results show that using CMR is also a cost-effective strategy and supports the wider adoption of this modality.