A Cost Analysis of Cardiac Magnetic Resonance Imaging in the Diagnostic Pathway of Patients Presenting With Unexplained Acute Myocardial Injury and Culprit-Free Coronary Angiography

Abstract

Aims: To determine financial implications of implementing cardiac magnetic resonance imaging (CMR) in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography.Methods and Results: We performed a focused cost-benefit analysis using a hypothetical population of 2,000 patients with unexplained acute myocardial injury and normal coronary angiography divided into two groups to receive either standard or CMR guided management over a 10-year period. As healthcare practice and costs considerably vary geographically and over time, an algorithm with 15 key variables was developed to permit user-defined calculations of cost-benefit and other analyses. Using current UK costs, routine use of CMR increases healthcare spending by 14% per patient in the first year. After 7 years, CMR guided practice is cost neutral, reducing cost by 3% per patient 10 years following presentation. In addition, CMR -guided therapy results in 7 fewer myocardial infarctions and 14 fewer major bleeding events per 1,000 patients over a 10-year period. The three most sensitive variables were, in decreasing order, the cost of CMR, the cost of ticagrelor and the percentage of the population with MI requiring DAPT.Conclusion: Routine use of CMR in patients with unexplained acute myocardial injury and normal coronary angiography is associated with cost reductions in the medium to long term. The initial higher cost of CMR is offset over time and delivers a more personalized and higher quality of care.

The Merits, Limitations, and Future Directions of Cost-Effectiveness Analysis in Cardiac MRI with a Focus on Coronary Artery Disease: A Literature Review

“…Regardless of such challenges, several studies have explored the cost-effectiveness and clinical utility of CMR. One such study conducted a cost–benefit analysis on a modeled population of patients with acute myocardial infarction (MI) to compare the cost of standard therapy (dual antiplatelet therapy and/or aspirin for life) versus CMR-guided management over a 10-year period [ 24 ]. Researchers used a hypothetical population consisting of 2000 patients with acute MI and normal coronary angiography [ 24 ].…”

“…One such study conducted a cost–benefit analysis on a modeled population of patients with acute myocardial infarction (MI) to compare the cost of standard therapy (dual antiplatelet therapy and/or aspirin for life) versus CMR-guided management over a 10-year period [ 24 ]. Researchers used a hypothetical population consisting of 2000 patients with acute MI and normal coronary angiography [ 24 ]. Half of the patients were assigned to standard therapy and the other half to CMR-guided management.…”

“…Half of the patients were assigned to standard therapy and the other half to CMR-guided management. Analysis was performed based on United Kingdom costs with outcomes varying based on the time period [ 24 ]. Within the first year, the routine use of CMR to identify patients with a true MI increased spending by 14% per patient.…”

“…By seven years, CMR-guided practice was cost-neutral. After 10 years, CMR-guided management was found to reduce costs by 3% per patient [ 24 ]. These findings suggested that while CMR-guided management of acute MI may have increased costs in the first few years, it is cost-effective when managing long-term patients.…”