Optimizing CAD diagnosis in China with CT angiography

• Published in: Journal of cardiovascular computed tomography 2009-05, Vol.3 (3), p.153-158
• Main Authors: Cheng, Mindy M., MS, Lu, Bin, MD, Hu, Sheng-Shou, MD, Marelli, Claudio, MD, Higashi, Mitchell K., PhD, Patel, Pankaj A., PharmD, MS, Li, Jiacheng, BM, Veenstra, David L., PharmD, PhD
• Format: Article
• Language: English
• Subjects: Cardiovascular; China; Coronary Angiography - economics; Coronary Angiography - methods; Coronary artery disease (CAD); Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - economics; Coronary computed tomography angiography (CTA); Cost-effectiveness; Humans; Tomography, X-Ray Computed - methods
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2009.03.005

Background Diagnosis of coronary artery disease (CAD) in China with coronary angiography (CA) can be challenging because of high disease prevalence and limited resources. Coronary computed tomography angiography (CTA) may provide an opportunity to minimize invasive diagnostic procedures among intermediate-risk patients indicated for CA and increase patient access to diagnosis of CAD in a cost-effective manner. Objective This study was conducted to evaluate the potential costs and efficiency of using CTA in combination with CA to optimize diagnosis and care of patients with suspected CAD in China. Methods We conducted a cost-consequences analysis from the perspective of Fuwai Hospital in Beijing. We developed a decision-analytic model that compared a diagnostic strategy of CA only with a strategy of CTA in combination with CA for patients with intermediate pretest probability of significant CAD and indicated for CA. Results In the base-case analysis, use of CTA in combination with CA led to a cost-savings of US$597 per patient evaluated compared with the CA-only diagnostic strategy. The hospital cost per angiography-confirmed diagnosis of CAD was US$8103 for CTA followed by CA compared with US$9148 for CA only. The unit cost of CA, and CTA sensitivity were the most influential parameters on the results. The range of cost savings associated with use of CTA followed by CA was US$768–US$461 per patient over a CAD prevalence range of 14%–59%. Conclusion The results of our study suggest that CTA implementation in China for intermediate-risk patients indicated for CA may optimize the patient population that undergoes invasive CA procedures and may provide cost savings for Chinese hospitals.