Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of XXXX .

@entity1 @entity453
PURPOSE: We compared cost-effectiveness and potential lifetime benefits of using dual-energy computed tomography (DECT) for myocardial perfusion assessment instead of single photon emission computed tomography (SPECT) for the workup of @entity453 ( @entity453 ). MATERIALS AND METHODS: A decision and simulation model was developed to estimate cost and health effects of using DECT myocardial perfusion imaging instead of SPECT for identifying @entity1 in need of invasive imaging and possible revascularization. The model was based on the performance indices of stress/rest DECT compared with stress/rest SPECT for detecting myocardial perfusion deficits in 50 @entity1 (mean age 61  10 years) with @entity453 . Stress/rest perfusion and delayed enhancement cardiac MRI served as reference standard. For DECT a reimbursement of US 1700 was assumed but costs of cardiac MRI were not included in the model. All other actual healthcare costs in these @entity1 were derived from MUSC's hospital billing system. RESULTS: Compared with cardiac MRI, DECT (versus SPECT) had 90% (85%) sensitivity and 71% (58%) specificity for identifying @entity1 with obstructive @entity453 . Compared with the no imaging and no treatment strategy, routine SPECT gained 13.49 quality-adjusted life-years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US 3557 (in 2010) per QALY. In comparison, DECT ICER was lower (US 3.191 per QALY, p=0.0002) and an additional 0.64 QALYs was obtained (total of 14.13 QALYs) if compared with the SPECT strategy as well as the no imaging and no treatment strategy. CONCLUSION: Using DECT as the first-line imaging test for myocardial perfusion for the workup of @entity1 with @entity453 has the potential to provide gains in QALYs, while lowering costs if compared to routine myocardial perfusion SPECT.
