Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography

Objectives To determine the costs and cost-effectiveness of a diagnostic strategy including computed tomography coronary angiography (CTCA) in comparison with invasive conventional coronary angiography (CA) for the detection of significant coronary artery disease from the point of view of the healthcare provider. Methods The average cost per CTCA was determined via a micro-costing method in four French hospitals, and the cost of CA was taken from the 2011 French National Cost Study that collects data at the patient level from a sample of 51 public or not-for-profit hospitals. Results The average cost of CTCA was estimated to be 180€ (95 % CI 162–206€) based on the use of a 64-slice CT scanner active for 10 h per day. The average cost of CA was estimated to be 1,378€ (95 % CI 1,126–1,670€). The incremental cost-effectiveness ratio of CA for all patients over a strategy including CTCA triage in the intermediate risk group, no imaging test in the low risk group, and CA in the high risk group, was estimated to be 6,380€ (95 % CI 4,714–8,965€) for each additional correctly classified patient. This strategy correctly classifies 95.3 % (95 % CI 94.4–96.2) of all patients in the population studied. Conclusions A strategy of CTCA triage in the intermediate-risk group, no imaging test in the low-risk group, and CA in the high-risk group, has good diagnostic accuracy and could significantly cut costs. Medium-term and long-term outcomes need to be evaluated in patients with coronary stenosis potentially misclassified by CTCA due to false negative examinations.