@article{3219180,
    title = "Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries",
    author = "Moschetti, K. and Kwong, R.Y. and Petersen, S.E. and Lombardi, M. and Garot, J. and Atar, D. and Rademakers, F.E. and Sierra-Galan, L.M. and Mavrogeni, S. and Li, K. and Fernandes, J.L. and Schneider, S. and Pinget, C. and Ge, Y. and Antiochos, P. and Deluigi, C. and Bruder, O. and Mahrholdt, H. and Schwitter, J.",
    journal = "JACC Cardiovascular Imaging",
    year = "2022",
    volume = "15",
    number = "4",
    pages = "607-625",
    publisher = "HANLEY & BELFUS-ELSEVIER INC",
    issn = "1936-878X",
    doi = "10.1016/j.jcmg.2021.11.008",
    keywords = "adult;  all cause mortality;  Article;  Asia;  cardiovascular magnetic resonance;  cerebrovascular accident;  clinical practice;  comparative study;  controlled study;  coronary angiography;  coronary artery disease;  cost benefit analysis;  cost control;  cost effectiveness analysis;  cost minimization analysis;  diabetes mellitus;  disease burden;  dyslipidemia;  Europe;  female;  follow up;  fractional flow reserve;  health care system;  heart muscle revascularization;  human;  hypertension;  major adverse cardiac event;  major clinical study;  male;  middle aged;  physiological stress;  practice guideline;  revascularization;  sensitivity analysis;  South and Central America;  thorax pain;  United States",
    abstract = "Objectives: The aim of this study was to compare the costs of a noninvasive cardiac magnetic resonance (CMR)–guided strategy versus 2 invasive strategies with and without fractional flow reserve (FFR). Background: Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion CMR has excellent accuracy to detect CAD. International guidelines recommend as a first step noninvasive testing of patients in stable condition with known or suspected CAD. However, nonadherence in routine clinical practice is high. Methods: In the EuroCMR (European Cardiovascular Magnetic Resonance) registry (n = 3,647, 59 centers, 18 countries) and the U.S.-based SPINS (Stress-CMR Perfusion Imaging in the United States) registry (n = 2,349, 13 centers, 11 states), costs were calculated for 12 health care systems (8 in Europe, the United States, 2 in Latin America, and 1 in Asia). Costs included diagnostic examinations (CMR and x-ray coronary angiography [CXA] with and without FFR), revascularizations, and complications during 1-year follow-up. Seven subgroup analyses covered low- to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization at the treating physician's discretion (CMR+CXA strategy). In the hypothetical invasive CXA+FFR strategy, costs were calculated for initial CXA and FFR in vessels with ≥50% stenoses, assuming the same proportion of revascularizations and complications as with the CMR+CXA strategy and FFR-positive rates as given in the published research. In the CXA-only strategy, costs included CXA and revascularizations of ≥50% stenoses. Results: Consistent cost savings were observed for the CMR+CXA strategy compared with the CXA+FFR strategy in all 12 health care systems, ranging from 42% ± 20% and 52% ± 15% in low-risk EuroCMR and SPINS patients with atypical chest pain, respectively, to 31% ± 16% in high-risk SPINS patients with known CAD (P < 0.0001 vs 0 in all groups). Cost savings were even higher compared with CXA only, at 63% ± 11%, 73% ± 6%, and 52% ± 9%, respectively (P < 0.0001 vs 0 in all groups). Conclusions: In 12 health care systems, a CMR+CXA strategy yielded consistent moderate to high cost savings compared with a hypothetical CXA+FFR strategy over the entire spectrum of risk. Cost savings were consistently high compared with CXA only for all risk groups. © 2022 The Authors"
}