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Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach

OBJECTIVE: Given recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR)...

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Autores principales: Nazir, Muhummad Sohaib, Rodriguez-Guadarrama, Yael, Rua, Tiago, Bui, Khan Ha, Buylova Gola, Anna, Chiribiri, Amedeo, McCrone, Paul, Plein, Sven, Pennington, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8981340/
https://www.ncbi.nlm.nih.gov/pubmed/35379740
http://dx.doi.org/10.1136/openhrt-2021-001700
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author Nazir, Muhummad Sohaib
Rodriguez-Guadarrama, Yael
Rua, Tiago
Bui, Khan Ha
Buylova Gola, Anna
Chiribiri, Amedeo
McCrone, Paul
Plein, Sven
Pennington, Mark
author_facet Nazir, Muhummad Sohaib
Rodriguez-Guadarrama, Yael
Rua, Tiago
Bui, Khan Ha
Buylova Gola, Anna
Chiribiri, Amedeo
McCrone, Paul
Plein, Sven
Pennington, Mark
author_sort Nazir, Muhummad Sohaib
collection PubMed
description OBJECTIVE: Given recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the reference standard. METHODS: A probabilistic decision-analytical model was developed which modelled a cohort of patients with stable angina. We investigated 17 diagnostic strategies between standalone and combination of different imaging tests to establish a correct diagnosis of CAD, using no testing as the baseline reference. These tests included CT coronary angiography (CTCA), stress echocardiography, CT-based FFR, single-photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), positron emission tomography, ICA, and ICA with FFR. Incremental cost-effectiveness ratios were calculated as the additional cost per correct diagnosis. RESULTS: SPECT followed by CTCA and ICA-FFR is the most cost-effective strategy between a cost-effectiveness threshold (CET) value of £1000–£3000 per correct diagnosis. CMR followed by CTCA and ICA-FFR is cost-effective within a CET range of £3000–£17 000 per correct diagnosis. CMR and ICA-FFR is cost-effective within a CET range of £17 000–£24 000. ICA-FFR as first line is the most-cost effective if the CET value exceeds the £24 000 per correct diagnosis. Sensitivity analysis showed that direct ICA-FFR may be cost-effective in patients with a high pre-test probability of CAD. CONCLUSION: First-line testing with functional imaging is cost-effective at low to intermediate value of correct diagnosis in patients with low to intermediate risk of CAD. ICA is not cost effective although ICA-FFR may be at higher CET.
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spelling pubmed-89813402022-04-22 Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach Nazir, Muhummad Sohaib Rodriguez-Guadarrama, Yael Rua, Tiago Bui, Khan Ha Buylova Gola, Anna Chiribiri, Amedeo McCrone, Paul Plein, Sven Pennington, Mark Open Heart Health Care Delivery, Economics and Global Health Care OBJECTIVE: Given recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the reference standard. METHODS: A probabilistic decision-analytical model was developed which modelled a cohort of patients with stable angina. We investigated 17 diagnostic strategies between standalone and combination of different imaging tests to establish a correct diagnosis of CAD, using no testing as the baseline reference. These tests included CT coronary angiography (CTCA), stress echocardiography, CT-based FFR, single-photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), positron emission tomography, ICA, and ICA with FFR. Incremental cost-effectiveness ratios were calculated as the additional cost per correct diagnosis. RESULTS: SPECT followed by CTCA and ICA-FFR is the most cost-effective strategy between a cost-effectiveness threshold (CET) value of £1000–£3000 per correct diagnosis. CMR followed by CTCA and ICA-FFR is cost-effective within a CET range of £3000–£17 000 per correct diagnosis. CMR and ICA-FFR is cost-effective within a CET range of £17 000–£24 000. ICA-FFR as first line is the most-cost effective if the CET value exceeds the £24 000 per correct diagnosis. Sensitivity analysis showed that direct ICA-FFR may be cost-effective in patients with a high pre-test probability of CAD. CONCLUSION: First-line testing with functional imaging is cost-effective at low to intermediate value of correct diagnosis in patients with low to intermediate risk of CAD. ICA is not cost effective although ICA-FFR may be at higher CET. BMJ Publishing Group 2022-04-04 /pmc/articles/PMC8981340/ /pubmed/35379740 http://dx.doi.org/10.1136/openhrt-2021-001700 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Care Delivery, Economics and Global Health Care
Nazir, Muhummad Sohaib
Rodriguez-Guadarrama, Yael
Rua, Tiago
Bui, Khan Ha
Buylova Gola, Anna
Chiribiri, Amedeo
McCrone, Paul
Plein, Sven
Pennington, Mark
Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
title Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
title_full Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
title_fullStr Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
title_full_unstemmed Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
title_short Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
title_sort cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach
topic Health Care Delivery, Economics and Global Health Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8981340/
https://www.ncbi.nlm.nih.gov/pubmed/35379740
http://dx.doi.org/10.1136/openhrt-2021-001700
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