Cost-effectiveness of photon counting detector CT for coronary artery disease diagnostics: A Finnish healthcare perspective.

PURPOSE

The purpose of this study was to evaluate the cost-effectiveness of photon-counting detector computed tomography (PCD-CT) compared to energy-integrating detector CT (EID-CT) for coronary artery disease (CAD) diagnostics in the Finnish healthcare context.

METHODS

Two decision trees, incorporating local cost data and diagnostic pathways, were developed based on previously published Coronary Artery Disease - Reporting and Data System reclassification data for PCD-CT and EID-CT. A bootstrapping Monte Carlo simulation was used to model 10,000 virtual patients across a 10-year scanner lifespan. Two diagnostic scenarios were considered: one based on the diagnostic pathway of a previously published study (scenario 1) and another reflecting local clinical practice (scenario 2). Downstream testing costs and total diagnostic costs of both PCD-CT and EID-CT branches were assessed. The break-even point for PCD-CT investment was determined by including an assumed €1,500,000 price premium over EID-CT.

RESULTS

PCD-CT significantly reduced downstream diagnostic testing compared to EID-CT. In scenario 1, mean downstream costs per patient were €377.1 ± 11.5 for PCD-CT and €569.7 ± 11.7 for EID-CT, (33.8 % reduction, p < 0.001). In scenario 2, downstream costs were €831.7 ± 19.7 for PCD-CT and €1138.2 ± 18.3 for EID-CT (26.9 % reduction, p < 0.001). Total diagnostic costs, including CCTA, were also lower with PCD-CT. The cost-benefit threshold was reached after 7,880 and 4,950 patients for scenarios 1 and 2 respectively.

CONCLUSIONS

PCD-CT would be a cost-effective alternative to EID-CT in high-volume centers, reducing unnecessary downstream tests through improved diagnostic accuracy. These findings support its adoption in Finnish healthcare systems.