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. 2022 Apr;15(4):607-625.
doi: 10.1016/j.jcmg.2021.11.008. Epub 2022 Jan 12.

Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries

Karine Moschetti  1 , Raymond Y Kwong  2 , Steffen E Petersen  3 , Massimo Lombardi  4 , Jerome Garot  5 , Dan Atar  6 , Frank E Rademakers  7 , Lilia M Sierra-Galan  8 , Sophie Mavrogeni  9 , Kuncheng Li  10 , Juliano Lara Fernandes  11 , Steffen Schneider  12 , Christophe Pinget  13 , Yin Ge  2 , Panagiotis Antiochos  2 , Christina Deluigi  14 , Oliver Bruder  15 , Heiko Mahrholdt  16 , Juerg Schwitter  17
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Free article

Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries

Karine Moschetti et al. JACC Cardiovasc Imaging. 2022 Apr.
Free article

Abstract

Objectives: The aim of this study was to compare the costs of a noninvasive cardiac magnetic resonance (CMR)-guided strategy versus 2 invasive strategies with and without fractional flow reserve (FFR).

Background: Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion CMR has excellent accuracy to detect CAD. International guidelines recommend as a first step noninvasive testing of patients in stable condition with known or suspected CAD. However, nonadherence in routine clinical practice is high.

Methods: In the EuroCMR (European Cardiovascular Magnetic Resonance) registry (n = 3,647, 59 centers, 18 countries) and the U.S.-based SPINS (Stress-CMR Perfusion Imaging in the United States) registry (n = 2,349, 13 centers, 11 states), costs were calculated for 12 health care systems (8 in Europe, the United States, 2 in Latin America, and 1 in Asia). Costs included diagnostic examinations (CMR and x-ray coronary angiography [CXA] with and without FFR), revascularizations, and complications during 1-year follow-up. Seven subgroup analyses covered low- to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization at the treating physician's discretion (CMR+CXA strategy). In the hypothetical invasive CXA+FFR strategy, costs were calculated for initial CXA and FFR in vessels with ≥50% stenoses, assuming the same proportion of revascularizations and complications as with the CMR+CXA strategy and FFR-positive rates as given in the published research. In the CXA-only strategy, costs included CXA and revascularizations of ≥50% stenoses.

Results: Consistent cost savings were observed for the CMR+CXA strategy compared with the CXA+FFR strategy in all 12 health care systems, ranging from 42% ± 20% and 52% ± 15% in low-risk EuroCMR and SPINS patients with atypical chest pain, respectively, to 31% ± 16% in high-risk SPINS patients with known CAD (P < 0.0001 vs 0 in all groups). Cost savings were even higher compared with CXA only, at 63% ± 11%, 73% ± 6%, and 52% ± 9%, respectively (P < 0.0001 vs 0 in all groups).

Conclusions: In 12 health care systems, a CMR+CXA strategy yielded consistent moderate to high cost savings compared with a hypothetical CXA+FFR strategy over the entire spectrum of risk. Cost savings were consistently high compared with CXA only for all risk groups.

Keywords: CAD; CMR; FFR; cost-effectiveness; stress testing.

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Conflict of interest statement

Funding Support and Author Disclosures The EuroCMR registry is supported by unrestricted educational grants from the following companies (in alphabetical order): Life Sciences GE Healthcare, Medtronic, Novartis International, and Siemens Healthcare. Industry sponsorship was used exclusively for registry data management and analysis. All CMR scans reported in this registry were clinically indicated and thus funded by the regular health care providers. The SPINS study of the Society for Cardiovascular Magnetic Resonance (SCMR) was funded by the SCMR, using a research grant jointly sponsored by Siemens Healthineers and Bayer. These sponsors of SCMR provided financial support for the study but did not play a role in study design, data collection, analysis, interpretation, or manuscript drafting. Dr Petersen has served as a consultant to Circle Cardiovascular Imaging. Dr Fernandes has research agreements with Siemens. Dr Antiochos has received research funding from the Swiss National Science Foundation (grant P2LAP3_184037), the Novartis Foundation for Medical-Biological Research, the Bangerter-Rhyner Foundation, and the SICPA Foundation. Drs Bruder and Mahrholdt have received funding from European Union grant 005-GW02-067D. Dr Schwitter has received support from Bayer Healthcare and the Swiss Heart Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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