Burch Rex A, Siddiqui Taha A, Tou Leila C, Turner Kiera B, Umair Muhammad
Philadelphia College of Osteopathic Medicine, 625 Old Peachtree Rd NW, Suwanee, GA 30024, USA.
Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL 33431, USA.
J Cardiovasc Dev Dis. 2023 Jan 7;10(1):25. doi: 10.3390/jcdd10010025.
Given the high global disease burden of coronary artery disease (CAD), a major problem facing healthcare economic policy is identifying the most cost-effective diagnostic strategy for patients with suspected CAD. The aim of this review is to assess the long-term cost-effectiveness of coronary computed tomography angiography (CCTA) when compared with other diagnostic modalities and to define the cost and effective diagnostic utilization of computed tomography-fractional flow reserve (CT-FFR). A search was conducted through the MEDLINE database using PubMed with 16 of 119 manuscripts fitting the inclusion and exclusion criteria for review. An analysis of the data included in this review suggests that CCTA is a cost-effective strategy for both low risk acute chest pain patients presenting to the emergency department (ED) and low-to-intermediate risk stable chest pain outpatients. For patients with intermediate-to-high risk, CT-FFR is superior to CCTA in identifying clinically significant stenosis. In low-to-intermediate risk patients, CCTA provides a cost-effective diagnostic strategy with the potential to reduce economic burden and improve long-term health outcomes. CT-FFR should be utilized in intermediate-to-high risk patients with stenosis of uncertain clinical significance. Long-term analysis of cost-effectiveness and diagnostic utility is needed to determine the optimal balance between the cost-effectiveness and diagnostic utility of CT-FFR.
鉴于冠状动脉疾病（CAD）在全球疾病负担中占比很高，医疗保健经济政策面临的一个主要问题是确定针对疑似CAD患者的最具成本效益的诊断策略。本综述的目的是评估冠状动脉计算机断层扫描血管造影（CCTA）与其他诊断方式相比的长期成本效益，并确定计算机断层扫描 - 血流储备分数（CT-FFR）的成本和有效诊断利用率。通过使用PubMed在MEDLINE数据库中进行搜索，119篇手稿中有16篇符合纳入和排除标准以供综述。对本综述中包含的数据进行的分析表明，对于就诊于急诊科（ED）的低风险急性胸痛患者和低至中度风险的稳定胸痛门诊患者，CCTA是一种具有成本效益的策略。对于中高风险患者，CT-FFR在识别具有临床意义的狭窄方面优于CCTA。在低至中度风险患者中，CCTA提供了一种具有成本效益的诊断策略，有可能减轻经济负担并改善长期健康结果。对于临床意义不确定的狭窄的中高风险患者，应使用CT-FFR。需要对成本效益和诊断效用进行长期分析，以确定CT-FFR在成本效益和诊断效用之间的最佳平衡。
