Long-term health outcomes and cost-effectiveness of coronary CT angiography in patients with suspicion for acute coronary syndrome.
BACKGROUND
Randomized trials have shown favorable clinical outcomes for coronary CT angiography (CTA) in patients with suspected acute coronary syndrome (ACS). Our goal was to estimate the cost-effectiveness of coronary CTA as compared to alternative management strategies for ACP patients over lifetime.


METHODS
Markov microsimulation model was developed to compare cost-effectiveness of competitive strategies for ACP patients: 1) coronary CTA, 2) standard of care (SOC), 3) AHA/ACC Guidelines, and 4) expedited emergency department (ED) discharge protocol with outpatient testing. ROMICAT-II trial was used to populate the model with low to intermediate risk of ACS patient data, whereas diagnostic test-, treatment effect-, morbidity/mortality-, quality of life- and cost data were obtained from the literature. We predicted test utilization, costs, 1-, 3-, 10-year and over lifetime cardiovascular morbidity/mortality for each strategy. We determined quality adjusted life years (QALY) and incremental cost-effectiveness ratio. Observed outcomes in ROMICAT-II were used to validate the short-term model.


RESULTS
Estimated short-term outcomes accurately reflected observed outcomes in ROMICAT-II as coronary CTA was associated with higher costs ($4,490 vs. $2,513-$4,144) and revascularization rates (5.2% vs. 2.6%-3.7%) compared to alternative strategies. Over lifetime, coronary CTA dominated SOC and ACC/AHA Guidelines and was cost-effective compared to expedited ED protocol ($49,428/QALY). This was driven by lower cardiovascular mortality (coronary CTA vs. expedited discharge: 3-year: 1.04% vs. 1.10-1.17; 10-year: 5.06% vs. 5.21-5.36%; respectively).


CONCLUSION
Coronary CTA in patients with suspected ACS renders affordable long-term health benefits as compared to alternative strategies.
['Goehler|Alexander|A|', 'Mayrhofer|Thomas|T|', 'Pursnani|Amit|A|', 'Ferencik|Maros|M|', 'Lumish|Heidi S|HS|', 'Barth|Cordula|C|', 'Karády|Júlia|J|', 'Chow|Benjamin|B|', 'Truong|Quynh A|QA|', 'Udelson|James E|JE|', 'Fleg|Jerome L|JL|', 'Nagurney|John T|JT|', 'Gazelle|G Scott|GS|', 'Hoffmann|Udo|U|']
D054058:Acute Coronary Syndrome D016507:Cardiology Service, Hospital D000072226:Computed Tomography Angiography D017023:Coronary Angiography D017046:Cost Savings D003362:Cost-Benefit Analysis D003661:Decision Support Techniques D004636:Emergency Service, Hospital D005260:Female D017048:Health Care Costs D006801:Humans D008297:Male D008390:Markov Chains D008875:Middle Aged D018803:Models, Economic D011237:Predictive Value of Tests D011379:Prognosis D011788:Quality of Life D019057:Quality-Adjusted Life Years D012307:Risk Factors D013997:Time Factors
Acute coronary syndrome Coronary CTA Markov microsimulation model Acute chest pain Cost-effectiveness analysis