TY - JOUR T1 - Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography JF - Heart JO - Heart SP - 464 LP - 469 DO - 10.1136/heartjnl-2022-321211 VL - 109 IS - 6 AU - Praveen Thokala AU - Steve Goodacre AU - Katherine Oatey AU - Rachel O'Brien AU - David E Newby AU - Alasdair Gray Y1 - 2023/03/01 UR - http://heart.bmj.com/content/109/6/464.abstract N2 - 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 (£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.Data sharing not applicable as no datasets generated and/or analysed for this study. ER -