Table 3

Cost-effectiveness results

StrategyExpected costsExpected QALYsICERProbability cost-effective at £20 000 per QALYProbability cost-effective at £30 000 per QALY
Base case
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC
  Strategy 6—SPECT-CA£18 241.2211.5336470.01320.0006
  Strategy 3—ETT-CMR-CA£18 278.4611.538433£7778.810.53340.4708
  Strategy 5—CMR-CA£18 284.6611.538664£26 858.450.44820.5082
  Strategy 7—ETT-CA/CMR-CA£18 360.9411.539337£113 401.090.00260.0196
Scenario analyses
 60-year-old female with suspected CCS2, prior likelihood of disease based on CE-MARC
  Strategy 6—SPECT-CA£18 639.2912.0959290.0020
  Strategy 3—ETT-CMR-CA£18 657.2112.100839£3650.010.51060.4496
  Strategy 5—CMR-CA£18 661.0112.101021£20 913.980.47520.5048
  Strategy 7—ETT-CA/CMR-CA£18 728.1512.101611£113 667.980.01220.0456
 60-year-old male with suspected CCS4, prior likelihood of disease based on CE-MARC
  Strategy 6—SPECT-CA£18 153.4611.2405820.00620.001
  Strategy 3—ETT-CMR-CA£18 184.4311.246550£5188.790.45720.3606
  Strategy 5—CMR-CA£18 189.7411.246889£15 667.600.50680.5118
  Strategy 7—ETT-CA/CMR-CA£18 263.5311.248138£59 103.320.02920.1262
 50-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC
  Strategy 6—SPECT-CA£19 268.7314.2605930.0390.0038
  Strategy 3—ETT-CMR-CA£19 325.1014.265993£10 440.040.6370.5988
  Strategy 5—CMR-CA£19 333.9514.266170£49 967.170.31720.3872
  Strategy 7—ETT-CA/CMR-CA£19 419.7914.266693£164 185.660.00040.0098
 70-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC
  Strategy 6—SPECT-CA£16 440.388.6084740.01560.0018
  Strategy 3—ETT-CMR-CA£16 476.588.613096£7832.880.53280.4458
  Strategy 5—CMR-CA£16 482.548.613347£23 721.500.44260.51
  Strategy 7—ETT-CA/CMR-CA£16 558.848.614315£78 841.610.00740.042
 60-year-old male with suspected CCS2, prior likelihood of disease of 20%
  Strategy 3—ETT-CMR-CA£9463.0511.820481Dominant0.960.9646
 60-year-old male with suspected CCS2, prior likelihood of disease of 60%
  Strategy 6—SPECT-CA£27 393.8911.2372850.0090.0016
  Strategy 8—ETT-CA/SPECT-CA£27 461.9111.245557£8222.960.01660.0016
  Strategy 7—ETT-CA/CMR-CA£27 476.6611.247217£8878.230.94760.9856
  Strategy 2—ETT-CA£27 537.4011.247317£611 188.2900
 60-year-old male with suspected CCS2, prior likelihood of disease of 80%
  Strategy 6—SPECT-CA£36 330.3110.94436100
  Strategy 8—ETT-CA/SPECT-CA£36 357.0010.956250£2244.740.01220.0008
  Strategy 2—ETT-CA£36 383.5910.959560£8034.320.9060.9518
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, no cancer
  Strategy 6—SPECT-CA£18 272.7111.5282180.01240.0008
  Strategy 3—ETT-CMR-CA£18 309.9711.532987£7813.290.5190.4526
  Strategy 5—CMR-CA£18 316.0111.533223£25 557.830.46440.5256
  Strategy 7—ETT-CA/CMR-CA£18 392.3911.533912£110 833.850.00080.0202
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, revascularisation benefits based on the EUROPA study
  Strategy 6—SPECT-CA£18 216.4011.5551090.00460.0004
  Strategy 3—ETT-CMR-CA£18 246.2611.560269£5788.650.4890.4142
  Strategy 5—CMR-CA£18 251.6111.560534£20 134.760.4990.5374
  Strategy 7—ETT-CA/CMR-CA£18 323.8211.561396£83 829.100.00660.0472
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, absolute EQ-5D decrement
  Strategy 6—SPECT-CA£18 213.9911.5362430.01320.0016
  Strategy 3—ETT-CMR-CA£18 251.3111.541120£7654.600.58820.52
  Strategy 5—CMR-CA£18 257.6011.541305£34 029.550.3950.456
  Strategy 7—ETT-CA/CMR-CA£18 334.5111.541980£113 840.170.00280.0222
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, reidentification rate reduced by 50%
  Strategy 6—SPECT-CA£18 122.3011.5196880.0010.0002
  Strategy 3—ETT-CMR-CA£18 185.0411.530546£5778.220.2450.1068
  Strategy 5—CMR-CA£18 193.9811.531425£10 164.820.46340.289
  Strategy 7—ETT-CA/CMR-CA£18 283.7011.535112£24 335.950.29020.604
  Strategy 2—ETT-CA£18 407.2411.535246£922 885.8700
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, reidentification rate increased by 50%
  Strategy 6—SPECT-CA£18 209.4511.5414170.15120.0366
  Strategy 4—ETT-SPECT-CA£18 221.0411.541438£558 877.720.02260.0062
  Strategy 3—ETT-CMR-CA£18 236.1511.543805£6382.180.58920.6964
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, £0 cost increment of CMR compared with SPECT
  Strategy 6—SPECT-CA£18 233.2411.5382100.00340
  Strategy 3—ETT-CMR-CA£18 252.9311.543031£4084.380.44320.3964
  Strategy 5—CMR-CA£18 256.3611.543263£14 767.810.55220.594
  Strategy 7—ETT-CA/CMR-CA£18 346.2811.543933£134 122.190.0010.0096
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, £50 cost increment of CMR compared with SPECT
  Strategy 6—SPECT-CA£18 220.9211.5342990.11960.0122
  Strategy 3—ETT-CMR-CA£18 284.7711.539085£13 341.260.5560.5314
  Strategy 5—CMR-CA£18 294.7011.539318£42 421.270.29060.3858
  Strategy 7—ETT-CA/CMR-CA£18 350.6511.539985£83 991.250.01360.0644
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, £75 cost increment of CMR compared with SPECT
  Strategy 6—SPECT-CA£18 204.5911.5341790.3090.052
  Strategy 3—ETT-CMR-CA£18 290.0411.538979£17 801.450.42220.5128
  Strategy 7—ETT-CA/CMR-CA£18 342.5311.539887£57 789.580.0290.129
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, £100 cost increment of CMR compared with SPECT
  Strategy 6—SPECT-CA£18 267.5011.5324620.51540.1302
  Strategy 3—ETT-CMR-CA£18 375.0811.537255£22 441.830.19260.3788
  Strategy 7—ETT-CA/CMR-CA£18 413.9111.538184£41 832.100.02340.176
 60-year-old male with suspected CCS2, prior likelihood of disease based on CE-MARC, 20% of TP patients do not undergo revascularisation
  Strategy 6—SPECT-CA£17 917.9111.458550.02120.0014
  Strategy 3—ETT-CMR-CA£17 947.3511.46251£7440.790.55540.5222
  Strategy 5—CMR-CA£17 952.4811.46264£39 398.460.41960.473
  Strategy 7—ETT-CA/CMR-CA£18 024.8111.46289£290 686.9800.003
  • CA, coronary angiography; CCS, Canadian Cardiovascular Society; CMR, cardiovascular magnetic resonance; ETT, exercise treadmill testing; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; SPECT, single-photon emission CT.