The European Journal of Health Economics

, Volume 18, Issue 6, pp 731–742 | Cite as

Cost-effectiveness analysis of new generation coronary CT scanners for difficult-to-image patients

  • L. T. Burgers
  • W. K. Redekop
  • M. J. Al
  • S. K. Lhachimi
  • N. Armstrong
  • S. Walker
  • C. Rothery
  • M. Westwood
  • J. L. Severens
Original Paper

Abstract

Aims

New generation dual-source coronary CT (NGCCT) scanners with more than 64 slices were evaluated for patients with (known) or suspected of coronary artery disease (CAD) who are difficult to image: obese, coronary calcium score > 400, arrhythmias, previous revascularization, heart rate > 65 beats per minute, and intolerance of betablocker. A cost-effectiveness analysis of NGCCT compared with invasive coronary angiography (ICA) was performed for these difficult-to-image patients for England and Wales.

Methods and results

Five models (diagnostic decision model, four Markov models for CAD progression, stroke, radiation and general population) were integrated to estimate the cost-effectiveness of NGCCT for both suspected and known CAD populations. The lifetime costs and effects from the National Health Service perspective were estimated for three strategies: (1) patients diagnosed using ICA, (2) using NGCCT, and (3) patients diagnosed using a combination of NGCCT and, if positive, followed by ICA. In the suspected population, the strategy where patients only undergo a NGCCT is a cost-effective option at accepted cost-effectiveness thresholds. The strategy of using NGCCT in combination with ICA is the most favourable strategy for patients with known CAD. The most influential factors behind these results are the percentage of patients being misclassified (a function of both diagnostic accuracy and the prior likelihood), the complication rates of the procedures, and the cost price of a NGCCT scan.

Conclusion

The use of NGCCT might be considered cost-effective in both populations since it is cost-saving compared to ICA and generates similar effects.

Keywords

Cost-effectiveness CT scanner Coronary artery disease Radiation Imaging 

Supplementary material

10198_2016_824_MOESM1_ESM.doc (64 kb)
Table S1 presents the input parameters that were used for the economic evaluation (DOC 63 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • L. T. Burgers
    • 1
    • 2
  • W. K. Redekop
    • 1
    • 2
  • M. J. Al
    • 2
  • S. K. Lhachimi
    • 1
    • 2
    • 3
  • N. Armstrong
    • 4
  • S. Walker
    • 5
  • C. Rothery
    • 5
  • M. Westwood
    • 4
  • J. L. Severens
    • 1
    • 2
  1. 1.Institute for Medical Technology AssessmentErasmus University RotterdamRotterdamThe Netherlands
  2. 2.Institute of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
  3. 3.Research Group for Evidence-Based Public HealthBIPS -Leibniz-Institute für Prevention Research und EpidemiologyBremenGermany
  4. 4.Kleijnen Systematic Reviews LtdYorkUK
  5. 5.Centre for Health EconomicsUniversity of YorkYorkUK

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