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Cost-effective diagnostic cardiovascular imaging: when does it provide good value for the money?

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Abstract

To summarize the results of all original cost-utility analyses (CUAs) in diagnostic cardiovascular imaging (CVI) and characterize those technologies by estimates of their cost-effectiveness. We systematically searched the literature for original CVI CUAs published between 2000 and 2008. Studies were classified according to several variables including anatomy of interest (e.g. cerebrovascular, aorta, peripheral) and imaging modality under study (e.g. angiography, ultrasound). The results of each study, expressed as cost of the intervention to number of quality-adjusted life years saved ratio (cost/QALY) were additionally classified as favorable or not using $20,000, $50,000, and $100,000 per QALY thresholds. The distribution of results was assessed with Chi Square or Fisher exact test, as indicated. Sixty-nine percent of all cardiovascular imaging CUAs were published between 2000 and 2008. Thirty-two studies reporting 82 cost/QALY ratios were included in the final sample. The most common vascular areas studied were cerebrovascular (n = 9) and cardiac (n = 8). Sixty-six percent (21/32) of studies focused on sonography, followed by conventional angiography and CT (25%, n = 8, each). Twenty-nine (35.4%), 42 (51.2%), and 53 (64.6%) ratios were favorable at WTP $20,000/QALY, $50,000/QALY, and $100,000/QALY, respectively. Thirty (36.6%) ratios compared one imaging test versus medical or surgical interventions; 26 (31.7%) ratios compared imaging to a different imaging test and another 26 (31.7%) to no intervention. Imaging interventions were more likely (P < 0.01) to be favorable when compared to observation, medical treatment or non-intervention than when compared to a different imaging test at WTP $100,000/QALY. The diagnostic cardiovascular imaging literature has growth substantially. The studies available have, in general, favorable cost-effectiveness profiles with major determinants relating to being compared against observation, medical or no intervention instead of other imaging tests.

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Acknowledgments

The work was done with partial support from NIH grant number K23-EB882-05 (PI: Rybicki).

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Authors and Affiliations

  1. Department of Radiology, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA

    Hansel J. Otero & Jorge A. Mendoza

  2. Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    Hansel J. Otero, Dan Greenberg & Peter J. Neumann

  3. Applied Imaging Science Laboratory, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA

    Frank J. Rybicki & Dimitrios Mitsouras

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  1. Hansel J. Otero
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Correspondence to Hansel J. Otero.

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Otero, H.J., Rybicki, F.J., Greenberg, D. et al. Cost-effective diagnostic cardiovascular imaging: when does it provide good value for the money?. Int J Cardiovasc Imaging 26, 605–612 (2010). https://doi.org/10.1007/s10554-010-9634-z

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