@article {Thokala464, author = {Praveen Thokala and Steve Goodacre and Katherine Oatey and Rachel O{\textquoteright}Brien and David E Newby and Alasdair Gray}, title = {Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography}, volume = {109}, number = {6}, pages = {464--469}, year = {2023}, doi = {10.1136/heartjnl-2022-321211}, publisher = {BMJ Publishing Group Ltd}, abstract = {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 careMethods 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 ({\textsterling}7414 vs {\textsterling}6845: mean difference {\textsterling}569, 95\% CI -{\textsterling}208 to {\textsterling}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 {\textsterling}481 per patient treated. At a threshold of {\textsterling}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.Data sharing not applicable as no datasets generated and/or analysed for this study.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/109/6/464}, eprint = {https://heart.bmj.com/content/109/6/464.full.pdf}, journal = {Heart} }