RT Journal Article
SR Electronic
T1 Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 464
OP 469
DO 10.1136/heartjnl-2022-321211
VO 109
IS 6
A1 Praveen Thokala
A1 Steve Goodacre
A1 Katherine Oatey
A1 Rachel O'Brien
A1 David E Newby
A1 Alasdair Gray
YR 2023
UL http://heart.bmj.com/content/109/6/464.abstract
AB 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.