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Original article
Direct costs and cost-effectiveness of dual-source computed tomography and invasive coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease
  1. Marc Dorenkamp1,2,
  2. Klaus Bonaventura3,4,
  3. Christian Sohns2,
  4. Christoph R Becker5,
  5. Alexander W Leber6
  1. 1Department of Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
  2. 2Department of Cardiology and Pneumology, Heart Center, Georg-August-University of Göttingen, Göttingen, Germany
  3. 3Department of Cardiology, Angiology, and Conservative Intensive Care, Klinikum Ernst von Bergmann, Potsdam, Germany
  4. 4University Outpatient Clinic Potsdam, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
  5. 5Department of Clinical Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
  6. 6Department of Cardiology, Heart Center Bogenhausen, Städtisches Klinikum München, Munich, Germany
  1. Correspondence to Dr Marc Dorenkamp, Department of Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553 Berlin, Germany; marc.dorenkamp{at}


Aims The study aims to determine the direct costs and comparative cost-effectiveness of latest-generation dual-source computed tomography (DSCT) and invasive coronary angiography for diagnosing coronary artery disease (CAD) in patients suspected of having this disease.

Methods The study was based on a previously elaborated cohort with an intermediate pretest likelihood for CAD and on complementary clinical data. Cost calculations were based on a detailed analysis of direct costs, and generally accepted accounting principles were applied. Based on Bayes' theorem, a mathematical model was used to compare the cost-effectiveness of both diagnostic approaches. Total costs included direct costs, induced costs and costs of complications. Effectiveness was defined as the ability of a diagnostic test to accurately identify a patient with CAD.

Results Direct costs amounted to €98.60 for DSCT and to €317.75 for invasive coronary angiography. Analysis of model calculations indicated that cost-effectiveness grew hyperbolically with increasing prevalence of CAD. Given the prevalence of CAD in the study cohort (24%), DSCT was found to be more cost-effective than invasive coronary angiography (€970 vs €1354 for one patient correctly diagnosed as having CAD). At a disease prevalence of 49%, DSCT and invasive angiography were equally effective with costs of €633. Above a threshold value of disease prevalence of 55%, proceeding directly to invasive coronary angiography was more cost-effective than DSCT.

Conclusions With proper patient selection and consideration of disease prevalence, DSCT coronary angiography is cost-effective for diagnosing CAD in patients with an intermediate pretest likelihood for it. However, the range of eligible patients may be smaller than previously reported.

  • Dual-source computed tomography
  • coronary angiography
  • coronary artery disease
  • cost analysis
  • cost-effectiveness
  • CT scanning
  • MRI
  • public health
  • imaging and diagnostics
  • atherosclerosis
  • fractional flow reserve

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  • MD and KB contributed equally to this work.

  • Competing interests MD, CRB and AWL have received consulting and lecture fees from Siemens Healthcare.

  • Ethics approval The present study is a cost-effectiveness analysis based on a previously elaborated patient cohort. Approval for this prior study was obtained from the Institutional Review Board of the University of Munich.

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