Cost-effectiveness of Cardiovascular Imaging for Stable Coronary Heart Disease

Objective: To assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): i) cardiovascular magnetic resonance (CMR); (ii) myocardial perfusion scintigraphy (MPS); and (iii) UK National Institute for Health and Care Excellence (NICE) guideline-guided care. Methods: Using UK data for 1,202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALY) and costs reflected UK pounds sterling 2016-17. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium, and high pre-test likelihood of CHD subgroups. Results: CMR had the highest estimated QALY gain overall (2.21 [95% credible interval 2.15,2.26] compared to 2.07 [1.92,2.20] NICE and 2.11 [2.01,2.22] MPS) and incurred comparable costs (overall £1625 [£1431,£1824] compared to £1753 [£1473,£2032] NICE and £1768 [£1572,£1989] MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective less costly) with incremental net health benefits per patient of 0.146 QALYs [-0.18,0.406] compared to NICE guidelines at a cost-effectiveness threshold of £15,000/QALY (93% probability of cost-effectiveness). Results were similar in the pre-test likelihood subgroups. Conclusions: CMR guided care is cost-effective overall and across all pre-test likelihood subgroups, compared to MPS and NICE guidelines.