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
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 1/2013

Open Access 01-12-2013 | Research

Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany

Authors: Julia Boldt, Alexander W Leber, Klaus Bonaventura, Christian Sohns, Martin Stula, Alexander Huppertz, Wilhelm Haverkamp, Marc Dorenkamp

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2013

Login to get access

Abstract

Background

Recent studies have demonstrated a superior diagnostic accuracy of cardiovascular magnetic resonance (CMR) for the detection of coronary artery disease (CAD). We aimed to determine the comparative cost-effectiveness of CMR versus single-photon emission computed tomography (SPECT).

Methods

Based on Bayes’ theorem, a mathematical model was developed to compare the cost-effectiveness and utility of CMR with SPECT in patients with suspected CAD. Invasive coronary angiography served as the standard of reference. Effectiveness was defined as the accurate detection of CAD, and utility as the number of quality-adjusted life-years (QALYs) gained. Model input parameters were derived from the literature, and the cost analysis was conducted from a German health care payer’s perspective. Extensive sensitivity analyses were performed.

Results

Reimbursement fees represented only a minor fraction of the total costs incurred by a diagnostic strategy. Increases in the prevalence of CAD were generally associated with improved cost-effectiveness and decreased costs per utility unit (ΔQALY). By comparison, CMR was consistently more cost-effective than SPECT, and showed lower costs per QALY gained. Given a CAD prevalence of 0.50, CMR was associated with total costs of €6,120 for one patient correctly diagnosed as having CAD and with €2,246 per ΔQALY gained versus €7,065 and €2,931 for SPECT, respectively. Above a threshold value of CAD prevalence of 0.60, proceeding directly to invasive angiography was the most cost-effective approach.

Conclusions

In patients with low to intermediate CAD probabilities, CMR is more cost-effective than SPECT. Moreover, lower costs per utility unit indicate a superior clinical utility of CMR.
Appendix
Available only for authorised users
Literature
1.
Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y: American Heart Association Statistics Committee and Stroke Statistics Subcommittee: Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009, 119: 480-6.CrossRefPubMed
2.
Reddy KS: Cardiovascular disease in non-Western countries. N Engl J Med. 2004, 350: 2438-40. 10.1056/NEJMp048024.CrossRefPubMed
3.
Allender S, Scarborough P, Peto V, Rayner M: European cardiovascular disease statistics. Eur Heart Network. 2008, 2008: 76-8.
4.
Cassar A, Holmes DR, Rihal CS, Gersh BJ: Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009, 84: 1130-46. 10.4065/mcp.2009.0391.PubMedCentralCrossRefPubMed
5.
Mastouri R, Sawada SG, Mahenthiran J: Current noninvasive imaging techniques for detection of coronary artery disease. Expert Rev Cardiovasc Ther. 2010, 8: 77-91. 10.1586/erc.09.164.CrossRefPubMed
6.
Burrell S, MacDonald A: Artifacts and pitfalls in myocardial perfusion imaging. J Nucl Med Technol. 2006, 34: 193-211.PubMed
7.
Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. New Engl J Med. 2000, 343: 1445-53. 10.1056/NEJM200011163432003.CrossRefPubMed
8.
Kim WY, Danias PG, Stuber M, Flamm SD, Plein S, Nagel E, Langerak SE, Weber OM, Pedersen EM, Schmidt M, Botnar RM, Manning WJ: Coronary magnetic resonance angiography for the detection of coronary stenoses. New Engl J Med. 2001, 345: 1863-9. 10.1056/NEJMoa010866.CrossRefPubMed
9.
Klem I, Heitner JF, Shah DJ, Sketch MH, Behar V, Weinsaft J, Cawley P, Parker M, Elliott M, Judd RM, Kim RJ: Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol. 2006, 47: 1630-8. 10.1016/j.jacc.2005.10.074.CrossRefPubMed
10.
Mahrholdt H, Klem I, Sechtem U: Cardiovascular MRI for detection of myocardial viability and ischaemia. Heart. 2007, 93: 122-9. 10.1136/hrt.2005.071290.PubMedCentralCrossRefPubMed
11.
Pennell DJ: Cardiovascular magnetic resonance. Circulation. 2010, 121: 692-705. 10.1161/CIRCULATIONAHA.108.811547.CrossRefPubMed
12.
Al-Saadi N, Nagel E, Gross M, Bornstedt A, Schnackenburg B, Klein C, Klimek W, Oswald H, Fleck E: Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance. Circulation. 2000, 101: 1379-83. 10.1161/01.CIR.101.12.1379.CrossRefPubMed
13.
Schwitter J, Nanz D, Kneifel S, Bertschinger K, Büchi M, Knüsel PR, Marincek B, Lüscher TF, von Schulthess GK: Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography. Circulation. 2001, 103: 2230-5. 10.1161/01.CIR.103.18.2230.CrossRefPubMed
14.
Nagel E, Klein C, Paetsch I, Hettwer S, Schnackenburg B, Wegscheider K, Fleck E: Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease. Circulation. 2003, 108: 432-7. 10.1161/01.CIR.0000080915.35024.A9.CrossRefPubMed
15.
Ishida N, Sakuma H, Motoyasu M, Okinaka T, Isaka N, Nakano T, Takeda K: Noninfarcted myocardium: correlation between dynamic first-pass contrast-enhanced myocardial MR imaging and quantitative coronary angiography. Radiology. 2003, 229: 209-16. 10.1148/radiol.2291021118.CrossRefPubMed
16.
Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, Dill T, Larsson HB, Flamm SD, Marquardt M, Johansson L: MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 2008, 29: 480-9. 10.1093/eurheartj/ehm617.CrossRefPubMed
17.
Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, Bijsterveld P, Ridgway JP, Radjenovic A, Dickinson CJ, Ball SG, Plein S: Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012, 379: 453-60. 10.1016/S0140-6736(11)61335-4.PubMedCentralCrossRefPubMed
18.
Moschetti K, Muzzarelli S, Pinget C, Wagner A, Pilz G, Wasserfallen JB, Schulz-Menger J, Nothnagel D, Dill T, Frank H, Lombardi M, Bruder O, Mahrholdt H, Schwitter J: 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. J Cardiovasc Magn Reson. 2012, 14: 35-10.1186/1532-429X-14-35.PubMedCentralCrossRefPubMed
19.
Patterson RE, Eng C, Horowitz SF, Gorlin R, Goldstein SR: Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease. J Am Coll Cardiol. 1984, 4: 278-89. 10.1016/S0735-1097(84)80214-4.CrossRefPubMed
20.
Patterson RE, Eisner RL, Horowitz SF: Comparison of cost-effectiveness and utility of exercise ECG, single photon emission computed tomography, positron emission tomography, and coronary angiography for diagnosis of coronary artery disease. Circulation. 1995, 91: 54-65. 10.1161/01.CIR.91.1.54.CrossRefPubMed
21.
Dorenkamp M, Bonaventura K, Sohns C, Becker CR, Leber AW: Direct costs and cost-effectiveness of dual-source computed tomography and invasive coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Heart. 2012, 98: 460-7. 10.1136/heartjnl-2011-300149.CrossRefPubMed
22.
McNeil BJ, Varady PD, Burrows BA, Adelstein SJ: Measures of clinical efficacy: cost-effectiveness calculations in the diagnosis and treatment of hypertensive renovascular disease. New Engl J Med. 1975, 293: 216-21. 10.1056/NEJM197507312930502.CrossRefPubMed
23.
Bruder O, Schneider S, Nothnagel D, Dill T, Hombach V, Schulz-Menger J, Nagel E, Lombardi M, van Rossum AC, Wagner A, Schwitter J, Senges J, Sabin GV, Sechtem U, Mahrholdt H: EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase. J Am Coll Cardiol. 2009, 54: 1457-66. 10.1016/j.jacc.2009.07.003.CrossRefPubMed
24.
Chaitman BR: Exercise stress testing. Heart Disease. Edited by: Braunwald E. 1997, Philadelphia: WB Saunders Company, 153-76. 5
25.
Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K, Schönberg SO, Luchner A, Strohm O, Ahlstrom H, Dill T, Hoebel N, Simor T: MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J. 2013, 34: 775-81. 10.1093/eurheartj/ehs022.CrossRefPubMed
26.
Henzlova MJ, Cerqueira MD, Mahmarian JJ, Yao SS: Quality assurance committee of the American society of nuclear cardiology. Stress protocols and tracers. J Nucl Cardiol. 2006, 13: e80-90. 10.1016/j.nuclcard.2006.08.011.CrossRefPubMed
27.
Holly TA, Abbott BG, Al-Mallah M, Calnon DA, Cohen MC, DiFilippo FP, Ficaro EP, Freeman MR, Hendel RC, Jain D, Leonard SM, Nichols KJ, Polk DM, Soman P: American society of nuclear cardiology. Single photon-emission computed tomography. J Nucl Cardiol. 2010, 17: 941-73. 10.1007/s12350-010-9246-y.CrossRefPubMed
28.
Hamm CW, Albrecht A, Bonzel T, Kelm M, Lange H, Schächinger V, Terres W, Voelker W: Diagnostic heart catheterization. Clin Res Cardiol. 2008, 97: 475-512.CrossRefPubMed
29.
30.
31.
Hermanns PM, Filler G, Roscher B: GOÄ 2012 – Gebührenordnung für Ärzte. 2012, Berlin & Heidelberg, Germany: Springer Verlag
32.
33.
34.
Stula M, Tillmanns C, Smetak N: Current training and reimbursement options for cardiovascular magnetic resonance. Herz. 2008, 33: 466-9.
35.
36.
Dorenkamp M, Bonaventura K, Leber AW, Boldt J, Sohns C, Boldt LH, Haverkamp W, Frei U, Roser M: Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension. Eur Heart J. 2013, 34: 451-61. 10.1093/eurheartj/ehs355.CrossRefPubMed
37.
Bonaventura K, Leber AW, Sohns C, Roser M, Boldt LH, Kleber FX, Haverkamp W, Dorenkamp M: Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease. Clin Res Cardiol. 2012, 101: 573-84. 10.1007/s00392-012-0428-2.CrossRefPubMed
38.
Neumann PJ, Rosen AB, Weinstein MC: Medicare and cost-effectiveness analysis. New Engl J Med. 2005, 353: 1516-22. 10.1056/NEJMsb050564.CrossRefPubMed
39.
Otero HJ, Rybicki FJ, Greenberg D, Mitsouras D, Mendoza JA, Neumann PJ: Cost-effective diagnostic cardiovascular imaging: when does it provide good value for the money?. Int J Cardiovasc Imaging. 2010, 26: 605-12. 10.1007/s10554-010-9634-z.PubMedCentralCrossRefPubMed
40.
41.
Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K, Schönberg SO, Debl K, Strohm O, Ahlstrom H, Dill T, Hoebel N, Simor T: MR-IMPACT investigators. 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). J Cardiovasc Magn Reson. 2012, 14: 61-10.1186/1532-429X-14-61.PubMedCentralCrossRefPubMed
42.
Bonow RO: What’s past is prologue: advances in cardiovascular imaging. Lancet. 2012, 379: 393-5. 10.1016/S0140-6736(11)61671-1.CrossRefPubMed
43.
Nacif MS, Arai AE, Lima JA, Bluemke DA: Gadolinium-enhanced cardiovascular magnetic resonance: administered dose in relationship to United States Food and Drug Administration (FDA) guidelines. J Cardiovasc Magn Reson. 2012, 14: 18-PubMedCentralPubMed
44.
Morton G, Ishida M, Schuster A, Hussain S, Schaeffter T, Chiribiri A, Nagel E: Perfusion cardiovascular magnetic resonance: comparison of an advanced, high-resolution and a standard sequence. J Cardiovasc Magn Reson. 2012, 14: 34-10.1186/1532-429X-14-34.PubMedCentralCrossRefPubMed
45.
Gebker R, Jahnke C, Manka R, Hucko T, Schnackenburg B, Kelle S, Klein C, Fleck E, Paetsch I: The role of dobutamine stress cardiovascular magnetic resonance in the clinical management of patients with suspected and known coronary artery disease. J Cardiovasc Magn Reson. 2011, 13: 46-10.1186/1532-429X-13-46.PubMedCentralCrossRefPubMed
46.
Mowatt G, Vale L, Brazzelli M, Hernandez R, Murray A, Scott N, Fraser C, McKenzie L, Gemmell H, Hillis G, Metcalfe M: Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Health Technol Assess. 2004, 8: 1-207.CrossRef
47.
Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, Maccarthy PA, Van’t Veer M, Pijls NH: Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010, 55: 2816-21. 10.1016/j.jacc.2009.11.096.CrossRefPubMed
48.
Dewey M, Hamm B: Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease. Eur Radiol. 2007, 17: 1301-9. 10.1007/s00330-006-0439-3.CrossRefPubMed
49.
Bruder O, Schneider S, Nothnagel D, Pilz G, Lombardi M, Sinha A, Wagner A, Dill T, Frank H, van Rossum A, Schwitter J, Nagel E, Senges J, Sabin G, Sechtem U, Mahrholdt H: Acute adverse reactions to gadolinium-based contrast agents in CMR: multicenter experience with 17,767 patients from the EuroCMR Registry. JACC Cardiovasc Imaging. 2011, 4: 1171-6. 10.1016/j.jcmg.2011.06.019.CrossRefPubMed
50.
Skinner JS, Smeeth L, Kendall JM, Adams PC, Timmis A, Chest Pain Guideline Development Group: NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Heart. 2010, 96: 974-8. 10.1136/hrt.2009.190066.CrossRefPubMed
Metadata
Title
Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany
Authors
Julia Boldt
Alexander W Leber
Klaus Bonaventura
Christian Sohns
Martin Stula
Alexander Huppertz
Wilhelm Haverkamp
Marc Dorenkamp
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2013
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/1532-429X-15-30

Other articles of this Issue 1/2013

Journal of Cardiovascular Magnetic Resonance 1/2013 Go to the issue

Research

A novel technique to quantify the instantaneous mitral regurgitant rate

Research

Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender

Research

Fetal circulation in left-sided congenital heart disease measured by cardiovascular magnetic resonance: a case–control study

Research

T1 and extracellular volume mapping in the heart: estimation of error maps and the influence of noise on precision

Research

PINOT NOIR: Pulmonic INsufficiency imprOvemenT with Nitric Oxide Inhalational Response

Research

Correction with blood T1 is essential when measuring post-contrast myocardial T1 value in patients with acute myocardial infarction