Cost-Effectiveness of Cardiovascular Magnetic Resonance in Diagnosing Coronary Artery Disease in the Australian Health Care System

Rebecca Kozor; Simon Walker; Bonny Parkinson; John Younger; Christian Hamilton-Craig; Joseph B Selvanayagam; John P Greenwood; Andrew J Taylor

doi:10.1016/j.hlc.2020.07.008

Cost-Effectiveness of Cardiovascular Magnetic Resonance in Diagnosing Coronary Artery Disease in the Australian Health Care System

Heart Lung Circ. 2021 Mar;30(3):380-387. doi: 10.1016/j.hlc.2020.07.008. Epub 2020 Aug 27.

Authors

Rebecca Kozor¹, Simon Walker², Bonny Parkinson³, John Younger⁴, Christian Hamilton-Craig⁵, Joseph B Selvanayagam⁶, John P Greenwood⁷, Andrew J Taylor⁸

Affiliations

¹ University of Sydney School of Medicine, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: rebecca.kozor@sydney.edu.au.
² Centre for Health Economics, University of York, York, UK.
³ Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia.
⁴ Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
⁵ Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Centre for Advanced Imaging, University of Queensland, Qld, Australia.
⁶ Flinders University, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
⁷ University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁸ Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia.

PMID: 32863111
DOI: 10.1016/j.hlc.2020.07.008

Abstract

Background: Coronary artery disease (CAD) remains a major public health problem in Australia and globally. A variety of imaging techniques allow for both anatomical and functional assessment of CAD and selection of the optimal investigation pathway is challenging. Cardiovascular magnetic resonance (CMR) is not widely used in Australia, partly due to perceived cost and lack of Federal Government reimbursement compared to the alternative techniques. The aim of this study was to estimate the cost-effectiveness of different diagnostic strategies in identifying significant CAD in patients with chest pain suggestive of angina using the evidence gathered in the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC trial), analysed from the Australian health care perspective.

Methods: A decision analytic model coupled with three distinct Markov models allowed eight potential clinical investigation strategies to be considered; combinations of exercise electrocardiogram stress testing (EST), single-photon emission computed tomography (SPECT), stress CMR, and invasive coronary angiography (ICA). Costs were from the Australian health care system in Australian dollars, and outcomes were measured in terms of quality-adjusted life-years. Parameter estimates were derived from the CE-MARC and EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease (EUROPA) trials, and from reviews of the published literature.

Results: The most cost-effective diagnostic strategy, based on a cost-effectiveness threshold of $45,000 to $75,000 per QALY gained, was EST, followed by stress CMR if the EST was positive or inconclusive, followed by ICA if the stress CMR was positive or inconclusive; this held true in the base case and the majority of scenario analyses.

Conclusions: This economic evaluation shows that an investigative strategy of stress CMR if EST is inconclusive or positive is the most cost-effective approach for diagnosing significant coronary disease in chest pain patients within the Australian health care system.

Keywords: Cardiovascular magnetic resonance; Coronary heart disease; Cost-effectiveness; Stress perfusion.

Publication types

Case Reports

MeSH terms

Aged
Australia
Coronary Artery Disease / diagnosis*
Coronary Artery Disease / economics
Cost-Benefit Analysis
Delivery of Health Care / economics*
Female
Humans
Magnetic Resonance Imaging, Cine / economics*
Male
Middle Aged
Models, Economic*