Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness of cardiovascular magnetic resonance imaging compared to common strategies in the diagnosis of coronary artery disease: a systematic review

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Cardiovascular magnetic resonance imaging (CMR) has established exceptional diagnostic utility and prognostic value in coronary artery disease (CAD). An assessment of the current evidence on the cost-effectiveness of CMR in patients referred for the investigation of CAD is essential for developing an economic model to evaluate the cost-effectiveness of CMR in CAD. We conducted a comprehensive search of multiple electronic databases, including PubMed, Scopus, Web of Science core collection, Embase, National Health Service Economic Evaluation Database (NHS EED), and health technology assessment, to identify relevant literature. After removing duplicates and screening the title/abstract, a total of 13 articles were deemed eligible for full-text assessment. We included studies that reported one or more of the following outcomes: incremental cost-effectiveness ratio (ICER), cost per quality-adjusted life year (QALYs), cost per life year gained, sensitivity and specificity rate as the primary outcome, and health utility measures or health-related quality of life as the secondary outcome. The quality of the included studies was assessed using the CHEERS 2022 guidelines. The findings of this study demonstrate that in patients undergoing urgent percutaneous coronary intervention, CMR over a one-year and lifetime horizon leads to higher quality-adjusted life years (QALYs) compared to current strategies in cases of multivessel disease. The systematic review indicates that the CMR-based strategy is more cost-effective when compared to standard methods such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA), and coronary angiography (CA) (CMR = $19,273, SPECT = $19,578, CCTA = $19,886, and immediate CA = $20,929). The results also suggest that the CMR strategy can serve as a cost-effective gatekeeping tool for patients at risk of obstructive CAD. A CMR-based strategy for managing patients with suspected CAD is more cost-effective compared to both invasive and non-invasive strategies, particularly in real-world patient populations with a low to intermediate prevalence of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated and analyzed during current study are not publicly available due to our institution policies, but are available from the corresponding author on a reasonable request.

References

  1. Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388(10053):1459–1544

    Article  Google Scholar 

  2. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, De Ferranti S, Després J-P, Fullerton HJ, Howard VJ (2015) Executive summary: heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 131(4):434–441

    Article  Google Scholar 

  3. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128

    Article  PubMed  Google Scholar 

  4. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A (2016) Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med 4(13)

  5. Members WG, Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES (2012) Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 125(1):e2–e220

    Google Scholar 

  6. Ge Y, Pandya A, Steel K, Bingham S, Jerosch-Herold M, Chen Y-Y, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A (2020) Cost-effectiveness analysis of stress cardiovascular magnetic resonance imaging for stable chest pain syndromes. 13(7):1505–1517

  7. Allender S, Scarborough P, O’Flaherty M, Capewell S (2008) Patterns of coronary heart disease mortality over the 20th century in England and Wales: possible plateaus in the rate of decline. BMC Public Health 8(1):1–12

    Article  Google Scholar 

  8. Kim HW, Klem I, Shah DJ, Wu E, Meyers SN, Parker MA, Crowley AL, Bonow RO, Judd RM, Kim RJ (2009) Unrecognized non-Q-wave myocardial infarction: prevalence and prognostic significance in patients with suspected coronary disease. PLoS Med 6(4):e1000057

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shah R, Heydari B, Coelho-Filho O, Murthy VL, Abbasi S, Feng JH, Pencina M, Neilan TG, Meadows JL, Francis S (2013) Stress cardiac magnetic resonance imaging provides effective cardiac risk reclassification in patients with known or suspected stable coronary artery disease. Circulation 128(6):605–614

    Article  PubMed  PubMed Central  Google Scholar 

  10. Brandenburg R (1980) Report of the WHO/ISFC task force on the definition and classification of cardiomyopathies. Br Heart J 44:672–673

    Article  Google Scholar 

  11. Richardson P (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 93:841–842

  12. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB (2006) Contemporary definitions and classification of the cardiomyopathies: an American Heart Association scientific statement from the council on clinical cardiology, heart failure and transplantation committee; quality of care and outcomes research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation 113(14):1807–1816

    Article  PubMed  Google Scholar 

  13. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kühl U, Maisch B, McKenna WJ (2008) Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 29(2):270–276

    Article  PubMed  Google Scholar 

  14. Arbustini E, Narula N, Dec GW, Reddy KS, Greenberg B, Kushwaha S, Marwick T, Pinney S, Bellazzi R, Favalli V (2013) The MOGE (S) classification for a phenotype–genotype nomenclature of cardiomyopathy: endorsed by the World Heart Federation. J Am Coll Cardiol 62(22):2046–2072

    Article  PubMed  Google Scholar 

  15. Chang S-A, Kim RJ (2016) The use of cardiac magnetic resonance in patients with suspected coronary artery disease: a clinical practice perspective. J Cardiovasc Ultrasound 24(2):96–103

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pezeshki PS, Ghorashi SM, Houshmand G, Ganjparvar M, Pouraliakbar H, Rezaei-Kalantari K, Fazeli A, Omidi N (2023) Feature tracking cardiac magnetic resonance imaging to assess cardiac manifestations of systemic diseases Heart Fail Rev 1–11

  17. Rezapour A, Azari S, Arabloo J, Pourasghari H, Behzadifar M, Alipour V, Omidi N, Sadeghian S, Aghajani H, Bragazzi NL (2021) Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review. Heart Fail Rev 26(3):587–601

    Article  PubMed  Google Scholar 

  18. van Waardhuizen CN, Khanji MY, Genders TS, Ferket BS, Fleischmann KE, Hunink MM, Petersen SE (2016) Comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic review. Eur Heart J-Qual Care Clin Outcomes 2(4):245–260

    Article  PubMed  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group* (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

  20. Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E (2022) Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Int J Technol Assess Health Care 38(1):e13

    Article  PubMed  Google Scholar 

  21. Stojanovic I, Schneider JE, Cooper J (2019) Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the US. J Med Econ 22(5):430–438

    Article  PubMed  Google Scholar 

  22. Stokes EA, Doble B, Pufulete M, Reeves BC, Bucciarelli-Ducci C, Dorman S, Greenwood JP, Anderson RA, Wordsworth S (2019) Cardiovascular magnetic resonance in emergency patients with multivessel disease or unobstructed coronary arteries: a cost-effectiveness analysis in the UK. BMJ Open 9(7):e025700

    Article  PubMed  PubMed Central  Google Scholar 

  23. Walker S, Girardin F, McKenna C, Ball SG, Nixon J, Plein S, Greenwood JP, Sculpher M (2013) Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study. Heart 99(12):873–881

    Article  PubMed  Google Scholar 

  24. Thom H, West NE, Hughes V, Dyer M, Buxton M, Sharples LD, Jackson CH, Crean AM, CECat study group (2014) Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial. BMJ open 4(2):e003419

    Article  PubMed  PubMed Central  Google Scholar 

  25. Moschetti K, Favre D, Pinget C, Pilz G, Petersen SE, Wagner A, Wasserfallen J-B, Schwitter J (2014) Comparative cost-effectiveness analyses of cardiovascular magnetic resonance and coronary angiography combined with fractional flow reserve for the diagnosis of coronary artery disease. J Cardiovasc Magn Reson 16(1):1–13

    Article  Google Scholar 

  26. Lorenzoni V, Bellelli S, Caselli C, Knuuti J, Underwood SR, Neglia D, Turchetti G (2019) Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: Results from the EVINCI study. 20(9):1437–1449

  27. Moschetti K, Petersen SE, Pilz G, Kwong RY, Wasserfallen J-B, Lombardi M, Korosoglou G, Van Rossum AC, Bruder O, Mahrholdt H (2015) Cost-minimization analysis of three decision strategies for cardiac revascularization: results of the “suspected CAD” cohort of the european cardiovascular magnetic resonance registry. J Cardiovasc Magn Reson 18(1):1–10

    Article  Google Scholar 

  28. Bertoldi EG, Stella SF, Rohde LEP, Polanczyk CA (2017) Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country. BMJ Open 7(4):e012652

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bertoldi EG, Stella SF, Rohde LE, Polanczyk CA (2016) Long-term cost-effectiveness of diagnostic tests for assessing stable chest pain: modeled analysis of anatomical and functional strategies. Clin Cardiol 39(5):249–256

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pletscher M, Walker S, Moschetti K, Pinget C, Wasserfallen J-B, Greenwood JP, Schwitter J, Girardin FR (2016) Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease. Eur Heart J-Qual Care Clin Outcomes 2(3):201–207

    Article  PubMed  Google Scholar 

  31. Boldt J, Leber AW, Bonaventura K, Sohns C, Stula M, Huppertz A, Haverkamp W, Dorenkamp M (2013) Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany. J Cardiovasc Magn Reson 15(1):1–11

    Article  Google Scholar 

  32. Petrov G, Kelle S, Fleck E, Wellnhofer E (2015) Incremental cost-effectiveness of dobutamine stress cardiac magnetic resonance imaging in patients at intermediate risk for coronary artery disease. Clin Res Cardiol 104(5):401–409

    Article  PubMed  Google Scholar 

  33. Kwong RY, Ge Y, Steel K, Bingham S, Abdullah S, Fujikura K, Wang W, Pandya A, Chen Y-Y, Mikolich JR, Boland S (2019) Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain. 74(14):1741–1755

  34. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, Bijsterveld P, Ridgway JP, Radjenovic A, Dickinson CJ, Ball SG (2012) Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. 379(9814):453–460

  35. Wichmann AB, Adang EM, Stalmeier PF, Kristanti S, Van den Block L, Vernooij-Dassen MJ, Engels Y (2017) The use of quality-adjusted life years in cost-effectiveness analyses in palliative care: mapping the debate through an integrative review. Palliat Med 31(4):306–322

    Article  PubMed  PubMed Central  Google Scholar 

  36. Centonze M, Steidler S, Casagranda G, Alfonsi U, Spagnolli F, Rozzanigo U, Palumbo D, Faletti R, De Cobelli F (2020) Cardiac-CT and cardiac-MR cost-effectiveness: a literature review. 125(11):1200–1207

  37. Moschetti K, Petersen SE, Pilz G, Kwong RY, Wasserfallen J-B, Lombardi M, Korosoglou G, Van Rossum AC, Bruder O, Mahrholdt H, Schwitter J (2015) Cost-minimization analysis of three decision strategies for cardiac revascularization: results of the “suspected CAD” cohort of the european cardiovascular magnetic resonance registry. 18(1):1–10

  38. Siddiqui TA, Chamarti KS, Tou LC, Demirjian GA, Noorani S, Zink S, Umair M (2022) The merits, limitations, and future directions of cost-effectiveness analysis in cardiac MRI with a focus on coronary artery disease: a literature review. J Cardiovas Dev Dis 9(10):357

    Google Scholar 

  39. Ghorashi SM, Fazeli A, Hedayat B, Mokhtari H, Jalali A, Ahmadi P, Chalian H, Bragazzi NL, Shirani S, Omidi N (2022) Comparison of conventional scoring systems to machine learning models for the prediction of major adverse cardiovascular events in patients undergoing coronary computed tomography angiography. Front Cardiovasc Med 9

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sanchez-Martinez S, Camara O, Piella G, Cikes M, González-Ballester MÁ, Miron M, Vellido A, Gómez E, Fraser AG, Bijnens B (2022) Machine learning for clinical decision-making: challenges and opportunities in cardiovascular imaging. Front Cardiovasc Med 8:2020

    Article  Google Scholar 

Download references

Acknowledgements

This study is an extract from the research project with the Code of Ethics IR.IUMS.REC.1400.941 from Iran University of Medical Sciences, which has been conducted at the Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran. We would like to thank all who helped us through writing the article.

Author information

Author notes

  1. Samad Azari and Hamid Pourasghari contributed equally as the first authors.

Authors and Affiliations

  1. Hospital Management Research Center, Health Management Research Institute, University of Medical Sciences, Tehran, Iran

    Samad Azari & Hamid Pourasghari

  2. Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran

    Samad Azari

  3. Health Management and Economics Research Center, Health Management Research Institute, University of Medical Sciences, Tehran, Iran

    Jalal Arabloo & Aziz Rezapour

  4. Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran

    Masoud Behzadifar

  5. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Rafie Khorgami

  6. Cardiovascular Disease Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Amir Fazeli, Seyyed Mojtaba Ghorashi, Shahrzad Salehbeigi & Negar Omidi

Authors
  1. Samad Azari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamid Pourasghari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amir Fazeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seyyed Mojtaba Ghorashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jalal Arabloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aziz Rezapour
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masoud Behzadifar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohammad Rafie Khorgami
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shahrzad Salehbeigi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Negar Omidi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SA had the idea for and designed the study and had full access to all the data. SA, AF, SMG, JA, AZ, SS, and MRK collected the data. SA and HP performed the statistical analysis. SA, AF, SMG, and JA mainly wrote the manuscript. MB and NO had critical revision of the manuscript. SA and HP had overall coordination. All authors provided critical feedback and contributed to the final manuscript.

Corresponding author

Correspondence to Negar Omidi.

Ethics declarations

Ethics approval

This study is an extract from the research project with the Code of Ethics IR.IUMS.REC 1400.941 from Iran University of Medical Sciences, which has been conducted and supported at the Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.

Conflict of interest

The authors declare no conflict of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azari, S., Pourasghari, H., Fazeli, A. et al. Cost-effectiveness of cardiovascular magnetic resonance imaging compared to common strategies in the diagnosis of coronary artery disease: a systematic review. Heart Fail Rev 28, 1357–1382 (2023). https://doi.org/10.1007/s10741-023-10334-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-023-10334-1

Keywords

Search

Navigation