Vecsey-Nagy Milán, Emrich Tilman, Tremamunno Giuseppe, Kravchenko Dmitrij, Taha Hagar Muhammad, Laux Gerald S, Schoepf U Joseph, O'Doherty Jim, Boussoussou Melinda, Szilveszter Bálint, Maurovich-Horvat Pál, Kroencke Thomas, Kabakus Ismail Mikdat, Spruill Suranyi Pal, Varga-Szemes Akos, Decker Josua A
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest 1122, Hungary.
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, 1 Langenbeckstraße, Mainz 55131, Germany.
J Cardiovasc Comput Tomogr. 2025 Jan-Feb;19(1):106-112. doi: 10.1016/j.jcct.2024.10.011. Epub 2024 Nov 4.
The increased specificity of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT over energy-integrating detector (EID)-CT for coronary CT angiography (CCTA) could defer unwarranted downstream tests. The objective of the study was to simulate the cost-effectiveness of UHR CCTA in stable chest pain patients with coronary calcifications.
A decision and simulation model was developed using Monte Carlo simulations with 1000 bootstrap resamples to estimate the costs associated with PCD-CT in lieu of EID-CT for CCTA and the referral for subsequent testing. The model was constructed using the diagnostic accuracy metrics of 55 coronary lesions in patients who underwent CCTA on both CT systems and subsequent invasive coronary angiography (ICA). Sensitivity and specificity were defined for each Coronary Artery Disease Reporting and Data System category. The aggregate healthcare expenditures were derived from the hospital billing system.
Assuming a projected cohort of 15,000 patients over the lifetime of the PCD-CT, its implementation resulted in a 18.9 % reduction in the number of functional follow-up tests (6330.3 ± 59.5 vs. 5135.7 ± 60.6, p < 0.001), a 6.0 % reduction in performed ICAs (1447.7 ± 36.2 vs. 1360.2 ± 34.7, p < 0.001), and a 9.4 % decrease in major procedure-related complications. Over a 10-year expected life expectancy, PCD-CT led to an average cost saving of $794.50 ± 18.50 per patient and an overall cost difference of $11,917,500 ± 4,350,169.
PCD-CT has the potential to reduce the financial burden on healthcare systems and procedure-related complications for stable chest pain patients with coronary calcification when compared to EID-CT.
在冠状动脉CT血管造影（CCTA）中，超高分辨率（UHR）光子计数探测器（PCD）CT相较于能量积分探测器（EID）CT具有更高的特异性，这可能会减少不必要的下游检查。本研究的目的是模拟UHR CCTA在伴有冠状动脉钙化的稳定型胸痛患者中的成本效益。
使用蒙特卡洛模拟和1000次自助重采样开发了一个决策和模拟模型，以估计用PCD-CT代替EID-CT进行CCTA以及后续检查转诊相关的成本。该模型使用在两种CT系统上均接受CCTA及后续有创冠状动脉造影（ICA）的患者中55个冠状动脉病变的诊断准确性指标构建。为每个冠状动脉疾病报告和数据系统类别定义了敏感性和特异性。总医疗费用来自医院计费系统。
假设在PCD-CT的使用期限内有15000名患者的预期队列，其应用导致功能随访检查数量减少18.9%（6330.3±59.5对5135.7±60.6，p<0.001），进行的ICA减少6.0%（1447.7±36.2对1360.2±34.7,p<0.001），主要手术相关并发症减少9.4%。在预期寿命为10年的情况下，PCD-CT使每位患者平均节省成本794.50±18.50美元，总成本差异为11917500±4350169美元。
与EID-CT相比，PCD-CT有可能减轻伴有冠状动脉钙化的稳定型胸痛患者的医疗系统经济负担和手术相关并发症。
