Department of Cardiology, Clinic Agatharied, Academic Teaching Hospital, University of Munich, Hausham, Germany.
Int J Cardiovasc Imaging. 2011 Jan;27(1):113-21. doi: 10.1007/s10554-010-9645-9. Epub 2010 Jun 4.
The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option.
新的成像技术的健康和经济影响日益成为相关政策问题。心脏磁共振成像（CMR）目前在包括德国在内的一些国家没有或没有得到充分报销，大概是因为证据基础有限。然而，尚不清楚它是否可以通过作为冠状动脉造影的准入标准有效地用于促进医疗决策并降低成本。我们研究了在疑似患有冠状动脉疾病（CAD）的患者中应用 CMR 是否通过避免转介进行心脏导管插入术来降低成本。我们使用倾向评分方法将 218 名 CMR 注册患者与之前研究的队列相匹配，该队列中 CMR 可靠地确定了发生重大心脏事件风险较低的患者。患者匹配的协变量包括合并症谱、人口统计学、与 CAD 相关的症状和 Morise 评分测量的 CAD 风险。我们根据 CMR 结果确定了延迟进行心脏导管插入术的患者比例。然后，我们使用心脏导管插入术和 CMR 成本的数据来计算实践模式改变的经济影响。CMR 将心脏导管插入术的利用率降低了 62.4%。根据估计的导管插入术成本€619，CMR 作为准入标准的使用使每位患者的成本平均降低了€90。CMR 成本超过€386 后即可实现节省。基于基线 Morise 评分，患有 CAD 低风险的患者的成本节约最大，但除了 CAD 风险最高的患者外，所有 Morise 亚组均存在成本节约。CMR 显著降低了疑似 CAD 患者的心脏导管插入术的利用率。每位患者的节省范围从 CAD 风险最低的患者的€323 到 CAD 风险最高但不在最高风险层的患者的€58。由于阴性 CMR 评估具有很高的阴性预测值，因此应进一步探索将其作为心脏导管插入术的准入标准作为治疗选择。
