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Original research
Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography
  1. Praveen Thokala1,
  2. Steve Goodacre1,
  3. Katherine Oatey2,
  4. Rachel O'Brien3,
  5. David E Newby4,
  6. Alasdair Gray2,3
  1. 1 ScHARR, The University of Sheffield, Sheffield, South Yorkshire, UK
  2. 2 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
  3. 3 Emergency Medicine Research Group (EMERGE), Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  4. 4 Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Praveen Thokala, ScHARR, The University of Sheffield, Sheffield, South Yorkshire, UK; p.thokala{at}


Objectives To estimate the cost-effectiveness of early CT coronary angiography (CTCA) for intermediate risk patients with suspected acute coronary syndrome (ACS), compared with standard care

Methods We performed within-trial economic analysis using data from the RAPID-CTCA randomised trial, and long-term modelling of cost-effectiveness using secondary data sources to estimate the cost-effectiveness of early CTCA compared with standard care for patients with suspected ACS attending acute hospitals in the UK. Cost-effectiveness was estimated as the incremental cost per quality-adjusted life year (QALY) gained, and the probability of each strategy being cost-effective at varying willingness-to-pay per QALY gained.

Results The within-trial analysis showed that there were no demonstrable differences in costs or QALYs between early CTCA and standard care, with point estimates suggesting higher costs (£7414 vs £6845: mean difference £569, 95% CI -£208 to £1335; p=0.1521) and lower QALYs (0.749 vs 0.758, mean difference −0.009, 95% CI −0.026 to 0.010; p=0.377) in the CTCA arm. The long-term economic analysis suggested that, on average, CTCA was slightly less effective than standard care alone with 0.025 quality-adjusted life years lost per patient treated and was more expensive with additional costs of £481 per patient treated. At a threshold of £20 000 per QALY, CTCA has 24% probability of being cost-effective.

Conclusions There are no demonstrable differences in within-trial costs and QALYs, and long-term cost-effectiveness modelling suggested higher long-term costs with CTCA and uncertain effect on long-term QALYs, making routine use of CTCA for suspected ACS unlikely to be a cost-effective use of NHS resources.

  • health care economics and organizations
  • computed tomography angiography
  • acute coronary syndrome

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors PT conducted all the health economic analysis. KO, RO, DEN, SG and AG were involved in the planning and reporting of the work. PT is responsible for the overall content as guarantor.

  • Funding The RAPID-CTCA trial was funded by the UK National Institute for Health Research Health Technology Assessment Programme (13/04/108).

  • Competing interests AG is a member of the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) Prioritisation Committee. SG is the chairperson of the NIHR CTU Standing Advisory Committee. He was the deputy director of the NIHR HTA programme; chairperson of the NIHR HTA Commissioning Committee and a member of the HTA Post-Funding Committee, HTA Funding Committee Policy Group and HTA Programme Oversight Committee. DEN is a Deputy Editor for BMJ Heart. He also reports unrestricted educational grants from Siemens Healthineers (Erlangen, Germany).

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.