Τίτλος:
Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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
Συγγραφείς:
Moschetti, K.
Kwong, R.Y.
Petersen, S.E.
Lombardi, M.
Garot, J.
Atar, D.
Rademakers, F.E.
Sierra-Galan, L.M.
Mavrogeni, S.
Li, K.
Fernandes, J.L.
Schneider, S.
Pinget, C.
Ge, Y.
Antiochos, P.
Deluigi, C.
Bruder, O.
Mahrholdt, H.
Schwitter, J.
Περιοδικό:
JACC Cardiovascular Imaging
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.jcmg.2021.11.008
