COST-EFFECTIVENESS ANALYSIS OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY AND INVASIVE CORONARY ANGIOGRAPHY FOR DIAGNOSIS OF CORONARY ARTERY DISEASE

Abstract

Background: The burden of cardiovascular diseases (CVDs) places significant pressure on healthcare
economics. Several imaging approaches exist for diagnosing coronary artery disease (CAD), with
varying accuracy and cost. A sufficient evidence base to justify the cost of any procedure is necessary.
Materials and Methods: In a prospective study, 58 patients with suspected CAD were recruited to
assess the cost-effectiveness of coronary computed tomography angiography (CCTA) compared with
invasive coronary angiography (ICA) based on Bayes’ theorem. Detailed activity-based cost analyses
of the two modalities were carried out.
Results: The costs of ICA (234.23 dollars) were found to be about 4.6 times higher than the cost of
CCTA (50.84 dollars). The cost of CCTA per patient increased as a linear function of increasing CAD
prevalence. In contrast, the cost per patient for ICA did not increase significantly. Concerning the costeffectiveness per CAD correct diagnosis, at a CAD prevalence of 55% CCTA and ICA were equally
effective with a cost of 448 dollars. CCTA is more cost-effective in patients with a prevalence of up to
54%. In contrast, ICA showed better cost-effectiveness for prevalence above 55%. In terms of qualityadjusted life-years gained (ΔQALY) with cost-effectiveness, the trend was similar, whereby at a CAD
prevalence of 55% CCTA and ICA were equally effective (150 dollars).
Discussion: ICA should be considered for patients with clinical characteristics indicating a high
prevalence of CAD. CCTA can be useful as a first-line test for risk assessment in patients with mild to
intermediate probability of suspected CAD.