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Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography

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Abstract

Objectives

To determine the costs and cost-effectiveness of a diagnostic strategy including computed tomography coronary angiography (CTCA) in comparison with invasive conventional coronary angiography (CA) for the detection of significant coronary artery disease from the point of view of the healthcare provider.

Methods

The average cost per CTCA was determined via a micro-costing method in four French hospitals, and the cost of CA was taken from the 2011 French National Cost Study that collects data at the patient level from a sample of 51 public or not-for-profit hospitals.

Results

The average cost of CTCA was estimated to be 180€ (95 % CI 162–206€) based on the use of a 64-slice CT scanner active for 10 h per day. The average cost of CA was estimated to be 1,378€ (95 % CI 1,126–1,670€). The incremental cost-effectiveness ratio of CA for all patients over a strategy including CTCA triage in the intermediate risk group, no imaging test in the low risk group, and CA in the high risk group, was estimated to be 6,380€ (95 % CI 4,714–8,965€) for each additional correctly classified patient. This strategy correctly classifies 95.3 % (95 % CI 94.4–96.2) of all patients in the population studied.

Conclusions

A strategy of CTCA triage in the intermediate-risk group, no imaging test in the low-risk group, and CA in the high-risk group, has good diagnostic accuracy and could significantly cut costs. Medium-term and long-term outcomes need to be evaluated in patients with coronary stenosis potentially misclassified by CTCA due to false negative examinations.

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Abbreviations

AGEPS:

Paris University Hospital Central Purchasing Service (Agence Générale des Equipements et Produits de Santé)

ATIH:

Technical Agency for Hospital Information (Agence technique de l’information sur l’hospitalisation)

CA:

Coronary angiography

CAD:

Coronary artery disease

CEA:

Cost-effectiveness analysis

CI:

Confidence interval

CRF:

Case report forms

CTCA:

Computed tomography coronary angiography

DRG:

Diagnosis-related group

ENC:

French National Cost Database (Etude nationale des coûts)

FN:

False negative

FP:

False positive

ICER:

Incremental cost-effectiveness ratio

mSv:

MilliSieverts

NPV:

Negative predictive value

PPV:

Positive predictive value

TN:

True negative

TP:

True positive

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Acknowledgments

Many thanks to the medical corps, statisticians, administrators, and purchasers who helped with the micro-costing. In particular, thanks to (in alphabetic order): Elisabeth Aoun (AGEPS), Dr. Michel Cymbalista (Montfermeil Hospital), Catherine Deneux (Centre Chirurgical Marie Lannelongue), Dr. Jean-François Deux (Henri Mondor Hospital), Dr. Franck Digne (Max Fourestier Hospital), Jean-Eric Lefèvre (AGEPS), Dr. Jean-François Paul (Centre Chirurgical Marie Lannelongue), Professor Alain Rahmouni (Henri Mondor Hospital), Rémy Raymond (Henri Mondor Hospital). This study was fully supported by a grant from the French Ministry of Health (Grant STIC IC 050126).

Conflict of interest

None.

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Authors and Affiliations

  1. URC Eco IdF, Paris Health Economics and Health Services Research Unit, AP-HP, Hôtel Dieu, 1 Place du Parvis Notre Dame, 75004, Paris, France

    Meryl Darlington, Antoine Filipovic Pierucci, Hassani Maoulida, Céline Quelen & Isabelle Durand-Zaleski

  2. Department of Cardiology, Henri Mondor Hospital and University of Paris Est Créteil, Créteil, France

    Pascal Gueret

  3. Department of Radiology, Bichat Hospital and Paris VII University, Paris, France

    Jean-Pierre Laissy

  4. Department of Biostatistics, Georges Pompidou Hospital and Paris V University, Paris, France

    Ralph Niarra & Gilles Chatellier

Authors
  1. Meryl Darlington
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  2. Pascal Gueret
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  7. Ralph Niarra
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  9. Isabelle Durand-Zaleski
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Corresponding author

Correspondence to Meryl Darlington.

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Darlington, M., Gueret, P., Laissy, JP. et al. Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography. Eur J Health Econ 16, 647–655 (2015). https://doi.org/10.1007/s10198-014-0616-2

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  • DOI: https://doi.org/10.1007/s10198-014-0616-2

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