Cost-effectiveness for imaging stable ischemic disease

Abstract

Stable ischemic heart disease remains a major cause of morbidity and mortality. Although there are multiple imaging modalities to diagnose and/or assist in the clinical management, the most cost-effective approach remains unclear. We reviewed the relevant and recent evidence-based clinical studies and trials to suggest the most cost-effective approach to stable ischemic heart disease. The limitations of these studies are discussed. Incorporating the results of recent multicenter trials, we suggest that for appropriate patients with coronary artery disease with any degree of stenosis or presence of coronary calcium, optimal medical therapy may be most cost-effective. Invasive coronary angiography and/or coronary revascularization would be primarily for non-responders or >/=50% left main stenosis. Stress cardiac magnetic imaging would be performed for those patients with non-diagnostic coronary CT angiography from motion and non-responders from optimal medical therapy in non-diagnostic coronary CT angiography group from high coronary calcium. These paths seem to be safe and cost-effective but requires modeling for confirmation.

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

“…Although in an observational registry of patients with suspected coronary disease in 41 centers in the United States and Canada, advanced imaging with PET and coronary CTA led to higher 2-year costs than did SPECT, 27 driven largely by more subsequent invasive procedures, research is mixed, with PET, CT, and CMR found to be cost effective in several other studies in comparison with alternative testing pathways. 28 , 29 …”

Cost-effectiveness analysis of including contrast-enhanced ultrasound in management of pancreatic cystic neoplasms

“…There are also many other studies reported in Literature that affirm the role of cost effectiveness analysis in the healthcare area. Terpenning S. and colleagues review the latest studies regarding the approach to stable ischemic heart disease and suggest a better cost-effective strategy [44]. Centonze M et al try to perform a cost-effective analysis focused on the role of Calcium Score, coronary computed tomography angiography and cardiac magnetic resonance [45].…”

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

“… [119] Among examples where stress CMR may be cost effective include patients with stable ischemic heart disease and non-diagnostic coronary CT angiography. [120] Utilization of CMR for cardiac anatomic disease may be more limited in the US relative to other countries.…”