Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2012

Open Access 01-12-2012 | Research

Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: Application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems

Authors: Karine Moschetti, Stefano Muzzarelli, Christophe Pinget, Anja Wagner, Günther Pilz, Jean-Blaise Wasserfallen, Jeanette Schulz-Menger, Detle Nothnagel, Torsten Dill, Herbert Frank, Massimo Lombardi, Oliver Bruder, Heiko Mahrholdt, Jürg Schwitter

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2012

Login to get access

Abstract

Background

Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD.

Methods

A subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings.

Results

In the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA.

Conclusion

This analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.
Appendix
Available only for authorised users
Literature
1.
Scarborough P, Bhatnagar P, Wickramasinghe K, Smolina K, Mitchell C, Rayner M: Coronary Heart Disease Statistics. 2010, British Heart Foundation, 2010
2.
WHO: The Atlas of Heart Disease and Stroke. 2004, World Health Organization
3.
Rosamond W, Flegal K, Furie K, et al: Heart Disease and Stroke Statistics—2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Am Heart Soc Circ. 2008, 117: e25-e26.
4.
Schweizerische Eidgenossenschaft: Décès: nombre, évolution et causes 2004 and 2008. 2009, Office fédéral de la statistique
5.
Roger V, Go A, Lloyd-Jones D, Adams R, Jarett D, Al E: Heart Disease and Stroke Statistics, 2011 Update: A Report From the American Heart Association. Circulation. 2011, 123: e18-e19. 10.1161/CIR.0b013e3182009701.PubMedCentralCrossRefPubMed
6.
Bruckenberger E, Winkler P: Herzbericht 2008 mit Transplantationschirurgie. 2009
7.
Schwitter J, Nanz D, Kneifel S, Bertschinger K: Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography. Circulation. 2001, 103: 2230-2235. 10.1161/01.CIR.103.18.2230.CrossRefPubMed
8.
Giang T, Nanz D, Coulden R, et al: Detection of coronary artery disease by magnetic resonance myocardial perfusion imaging with various contrast medium doses: first European multi-centre experience. Eur Heart J. 2004, 25: 1657-1665. 10.1016/j.ehj.2004.06.037.CrossRefPubMed
9.
Paetsch I, Jahnke C, Wahl A, et al: Comparison of Dobutamine Stress Magnetic Resonance, Adenosine Stress Magnetic Resonance, and Adenosine Stress Magnetic Resonance Perfusion. Circulation. 2004, 110: 835-2. 10.1161/01.CIR.0000138927.00357.FB.CrossRefPubMed
10.
Klem I, Heitner JF, Shah DJ, et al: Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use ofdelayed enhancement infarction imaging. J Am Coll Cardiol. 2006, 47: 1630-1638. 10.1016/j.jacc.2005.10.074.CrossRefPubMed
11.
Paetsch I, Jahnke C, Ferrari VA, et al: Determination of interobserver variability for identifying inducible left ventricular wall motion abnormalities during dobutamine stress magnetic resonance imaging. European Heart J. 2006, 27: 1459-1464.CrossRef
12.
Plein S, Kozerke S, Suerder D, et al: High spatial resolution myocardial perfusion cardiac magnetic resonance for the detection of coronary artery disease. European Heart J. 2008, 29: 2148-2155. 10.1093/eurheartj/ehn297.CrossRef
13.
Schwitter J, Wacker CM, van Rossum AC, et al: MR-IMPACT: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary ArteryDisease Trial: Comparison of perfusion CMR with Single Photon Emission Computed Tomography for the Detection of Coronary Artery Disease in a multicenter, Multivendor, Randomized Trial. European Heart J. 2008, 29: 480-489. 10.1093/eurheartj/ehm617.CrossRef
14.
Schwitter J, Arai AE: Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonance. Eur Heart J. 2011, 32: 799-809. 10.1093/eurheartj/ehq481.PubMedCentralCrossRefPubMed
15.
Schwitter J: CMR Update. Edited by: Schwitter J. 2012, Lausanne, Switzerland, Sd
16.
17.
Hundley W, Morgan T, Neagle C, et al: Magnetic resonance imaging determination of cardiac prognosis. Circulation. 2002, 106: 2328-2333. 10.1161/01.CIR.0000036017.46437.02.CrossRefPubMed
18.
Jahnke C, Nagel E, Gebker R, et al: Prognostic value of cardiac magnetic resonance stress tests: Adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation. 2007, 115: 1769-1776. 10.1161/CIRCULATIONAHA.106.652016.CrossRefPubMed
19.
Pilz G, Jeske A, Klos M, et al: Prognostic value of normal adenosine stress cardiac magnetic resonance imaging. Am J Cardiology. 2008, 101: 1408-1412. 10.1016/j.amjcard.2008.01.019.CrossRef
20.
Patel M, Peterson E, Dai D, et al: Low Diagnostic Yield of Elective Coronary Angiography. N Eng J Med. 2010, 362: 886-895. 10.1056/NEJMoa0907272.CrossRef
21.
Maeder M, et al: Swiss society of cardiology, Cardiovascular Medicine acts, Basel 8–10 June 2011 (abstract). 2011
22.
Horstkotte D, Wiemer M, van Buuren F: Performance figures of invasive cardiology in Germany, 2006 and 2007 focussing on coronary artery disease. Clin Res Cardiol. 2011, 100 (3): 187-190. 10.1007/s00392-010-0244-5.CrossRefPubMed
23.
24.
Pilz G, Patel P, Fell U, et al: Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications. Int J Cardiovasc Imaging. 2010, 27: 113-121.PubMedCentralCrossRefPubMed
25.
Miller C, Hwang W, Hoekstra J, et al: Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial. Ann Emerg Med. 2010, 56: 209-219. 10.1016/j.annemergmed.2010.04.009.PubMedCentralCrossRefPubMed
26.
Drummond M: Experimental versus observational data in the economic evaluation of pharmaceuticals. Med Decis Mak. 1998, 18: S12-S18. 10.1177/0272989X9801800203.CrossRef
27.
Bruder O, Schneider S, Nothnagel D, et al: EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase. J Am College Cardiology. 2009, 6: 1457-1466.CrossRef
28.
Bruder O, Schneider S, Nothnagel D: Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Multicenter Experience With 17767 Patients From the EuroCMR Registry. JACC Imaging. 2011, in press
29.
Schwitter J: CMR-Update. 2008, Zurich, 6-15. 1–240, 1
30.
Germany HiT: Health care systems in transition (HiT): Germany. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies. 2004, Copenhagen
31.
32.
33.
34.
35.
Switzerland HiT: Health care systems in transition (HiT): Switzerland. 2000, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen
36.
37.
38.
Fearon W, Bornschein B, Tonino P, et al: Economic Evaluation of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease. Circulation. 2010, 122: 2545-2550. 10.1161/CIRCULATIONAHA.109.925396.CrossRefPubMed
39.
Milbrandt E, Kersten A, Rahim M, et al: Growth of intensive care unit resource use and its estimated cost in Medicare. Critical Care Med. 2008, 36: 2504-2510.
40.
International Federation of Health Plans: Comparative Price Report Medical and Hospital Fees by Country. IFHP report. 2010
41.
Miller CD, Hwang W, Case D, et al: Stress CMR Imaging Observation Unit in the Emergency Department Reduces 1-Year Medical Care Costs in Patients With Acute Chest Pain: A Randomized Study for Comparison With Inpatient Care. JACC: Cardiovascular Imaging. 2011, 4: 862-870. 10.1016/j.jcmg.2011.04.016.PubMedCentralPubMed
42.
Coelho-Filho O, Seabra L, Mongeon F, Abdullah S, Francis S, Blankstein R: Stress Myocardial perfusion Imaging by CMR provides strong prognostic values to cardiac events regardless of patient’s sex. J Am Coll Cardiol Img. 2011, 4: 850-851.CrossRef
43.
Cullen A, Hall M, Golosinskiv A: Ambulatory Surgery in the United States, National Health Statistics Reports. 2006, 2009;Number 11
44.
Buie V, Owings M, DeFrances C, et al: National Hospital Discharge Survey: 2006. Nat Center Health Statistics Vital Health Stat. 2006, 13 (168): 2010-
45.
Madsen J, Bech J, Jørgensen E, et al: Yield of 5, 536 diagnostic coronary arteriographies: results from a data registry. Cardiology. 2002, 98: 191-194. 10.1159/000067318.CrossRefPubMed
46.
Tonino P, De Bruyne B, Pijls N, et al: Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention. N Engl J Med. 2009, 360: 213-214. 10.1056/NEJMoa0807611.CrossRefPubMed
47.
Litt H, Gatsonis C, Snyder B, et al: CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes. N Eng J Med. 2012, 366: 1393-1403. 10.1056/NEJMoa1201163.CrossRef
Metadata
Title
Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: Application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems
Authors
Karine Moschetti
Stefano Muzzarelli
Christophe Pinget
Anja Wagner
Günther Pilz
Jean-Blaise Wasserfallen
Jeanette Schulz-Menger
Detle Nothnagel
Torsten Dill
Herbert Frank
Massimo Lombardi
Oliver Bruder
Heiko Mahrholdt
Jürg Schwitter
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2012
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/1532-429X-14-35

Other articles of this Issue 1/2012

Journal of Cardiovascular Magnetic Resonance 1/2012 Go to the issue

Research

The protein binding substance Ibuprofen does not affect the T1 time or partition coefficient in contrast-enhanced cardiovascular magnetic resonance

Research

Infarct healing is a dynamic process following acute myocardial infarction

Research

Effects of combined deferiprone with deferoxamine on right ventricular function in thalassaemia major

Research

Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance

Research

Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial)

Research

Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress