TY - JOUR
TI - Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries
AU - Moschetti, K.
AU - Kwong, R.Y.
AU - Petersen, S.E.
AU - Lombardi, M.
AU - Garot, J.
AU - Atar, D.
AU - Rademakers, F.E.
AU - Sierra-Galan, L.M.
AU - Mavrogeni, S.
AU - Li, K.
AU - Fernandes, J.L.
AU - Schneider, S.
AU - Pinget, C.
AU - Ge, Y.
AU - Antiochos, P.
AU - Deluigi, C.
AU - Bruder, O.
AU - Mahrholdt, H.
AU - Schwitter, J.
JO - JACC Cardiovascular Imaging
PY - 2022
VL - 15
TODO - 4
SP - 607-625
PB - HANLEY & BELFUS-ELSEVIER INC
SN - 1936-878X
TODO - 10.1016/j.jcmg.2021.11.008
TODO - 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
TODO - 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
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