Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Eur J Health Econ. 2017 Jul;18(6):731-742. doi: 10.1007/s10198-016-0824-z. Epub 2016 Sep 20.
New generation dual-source coronary CT (NGCCT) scanners with more than 64 slices were evaluated for patients with (known) or suspected of coronary artery disease (CAD) who are difficult to image: obese, coronary calcium score > 400, arrhythmias, previous revascularization, heart rate > 65 beats per minute, and intolerance of betablocker. A cost-effectiveness analysis of NGCCT compared with invasive coronary angiography (ICA) was performed for these difficult-to-image patients for England and Wales.
Five models (diagnostic decision model, four Markov models for CAD progression, stroke, radiation and general population) were integrated to estimate the cost-effectiveness of NGCCT for both suspected and known CAD populations. The lifetime costs and effects from the National Health Service perspective were estimated for three strategies: (1) patients diagnosed using ICA, (2) using NGCCT, and (3) patients diagnosed using a combination of NGCCT and, if positive, followed by ICA. In the suspected population, the strategy where patients only undergo a NGCCT is a cost-effective option at accepted cost-effectiveness thresholds. The strategy of using NGCCT in combination with ICA is the most favourable strategy for patients with known CAD. The most influential factors behind these results are the percentage of patients being misclassified (a function of both diagnostic accuracy and the prior likelihood), the complication rates of the procedures, and the cost price of a NGCCT scan.
The use of NGCCT might be considered cost-effective in both populations since it is cost-saving compared to ICA and generates similar effects.
评估新一代双源冠状动脉 CT（NGCCT）扫描仪对（已知）或疑似患有冠状动脉疾病（CAD）且难以成像的患者的适用性，这些患者包括肥胖、冠状动脉钙化评分>400、心律失常、先前的血运重建、心率>65 次/分钟以及无法耐受β受体阻滞剂的患者。针对这些难以成像的患者，对 NGCCT 与有创冠状动脉造影（ICA）进行了英格兰和威尔士的成本效益分析。
整合了五种模型（诊断决策模型、四个 CAD 进展、中风、辐射和一般人群的 Markov 模型），以评估 NGCCT 对疑似和已知 CAD 患者的成本效益。从国家医疗服务体系的角度估算了三种策略的终生成本和效果：（1）使用 ICA 诊断的患者，（2）使用 NGCCT 的患者，以及（3）使用 NGCCT 诊断并在阳性结果时进行 ICA 检查的患者。在疑似人群中，仅接受 NGCCT 检查的策略在可接受的成本效益阈值下是一种具有成本效益的选择。对于已知 CAD 患者，使用 NGCCT 联合 ICA 的策略是最有利的策略。这些结果背后的最主要影响因素是患者被误诊的百分比（这是诊断准确性和先验可能性的函数）、程序的并发症率以及 NGCCT 扫描的成本价格。
在这两个患者群体中，NGCCT 的使用可能被认为具有成本效益，因为与 ICA 相比，它可以节省成本，并且产生相似的效果。
