Computed tomographic coronary angiography for diagnosing stable coronary artery disease - A cost-utility and cost-effectiveness analysis

Abstract

Background: To evaluate the lifetime potential benefits and cost-effectiveness of using 64 multidetector-row computed tomography coronary angiography (CTCA) as a noninvasive imaging modality for patients at risk for coronary artery disease (CAD). Methods and Results: A decision and cost-effective analysis using a Markov model was performed to compare 4 strategies: (1) no examination, (2) routine coronary angiography (CAG), (3) CTCA, or (4) medication without CAG or CTCA in persons at risk for stable CAD. Compared with the no examination and no treatment strategies, CTCA gained 0.551 quality-adjusted life-years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$15,581 (in 2007) per QALY. Routine CAG gained 0.012 QALYs compared with the CTCA strategy, with an ICER of US$445,276 per QALY. Conclusions: Using CTCA as the first-fine examination for 60-year-old men at risk for stable CAD achieved gains of QALY comparable to that of routine CAG, but at a lower cost.