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European Radiology

, Volume 17, Issue 5, pp 1301–1309 | Cite as

Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

  • Marc Dewey
  • Bernd Hamm
Cardiac

Abstract

We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of €4,435 (10% likelihood) to €1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society.

Keywords

Cost effectiveness Computed tomography Magnetic resonance imaging Coronary angiography Coronary disease Stress echocardiography Exercise electrocardiography 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Radiology, Charité, Medical SchoolHumboldt UniversityBerlinGermany

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