心血管磁共振与冠状动脉造影用于冠心病诊断的成本评估：欧洲心血管磁共振注册数据在德国、英国、瑞士和美国医疗体系中的应用。
Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems.
机构信息
Institute of Health Economics and Management (IEMS), University of Lausanne, Lausanne, Switzerland.
出版信息
J Cardiovasc Magn Reson. 2012 Jun 14;14(1):35. doi: 10.1186/1532-429X-14-35.
BACKGROUND
Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD.
METHODS
A subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings.
RESULTS
In the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA.
CONCLUSION
This analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.
背景
心血管磁共振（CMR）在诊断评估已知或疑似 CAD 患者方面具有良好的特征，并可进行风险分层。CMR 在 CAD 检测中的应用正在快速增长。然而，关于其成本效益的数据却很少。本研究的目的是比较两种策略在检测疑似冠心病（CAD）患者中显著冠状动脉狭窄的成本：1）首先进行 CMR 以评估心肌缺血和/或梗死瘢痕，然后将阳性患者（定义为存在缺血和/或梗死瘢痕）转诊至冠状动脉造影（CXA），而 2）假设所有患者都进行 CXA 作为单一检测以检测 CAD。
方法
使用欧洲 CMR 试点注册的一个亚组，其中包括 2717 例连续接受应激 CMR 的患者。这些患者中，21%为 CAD（缺血和/或梗死瘢痕）阳性，73%为阴性，6%为不确定并进行了额外的检查。使用每个测试的计费成本评估诊断成本。在德国、英国、瑞士和美国的医疗保健环境中，从医疗保健支付者的角度进行成本分析。
结果
在德国、英国和瑞士公共医疗保健系统中，与门诊 CXA 相比，CMR 驱动策略可节省 50%、25%和 23%的成本。如果 CXA 作为住院程序进行，成本节省分别为 46%、50%和 48%。在美国的情况下，与住院 CXA 相比，可节省 51%的成本，但与门诊 CXA 相比，CMR 高出 8%。
结论
从经济角度来看，本分析表明，对于疑似 CAD 患者，应鼓励使用 CMR 作为管理选择。
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