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. 2023 Feb 8;13(1):9.
doi: 10.1186/s13550-023-00954-x.

Cost-effectiveness of 82-Rubidium PET myocardial perfusion imaging for the diagnosis of myocardial ischemia depending on the prevalence of coronary artery disease

Maroua Mimouni  1 , Julie Bulsei  2 , Meryl Darlington  2 , Candice Estellat  3   4 , François Rouzet  5   6   7 , Fabien Hyafil  8   9 , Isabelle Durand-Zaleski  2   10   11   12 ; RUBIS Trial Group
Collaborators, Affiliations

Cost-effectiveness of 82-Rubidium PET myocardial perfusion imaging for the diagnosis of myocardial ischemia depending on the prevalence of coronary artery disease

Maroua Mimouni et al. EJNMMI Res. .

Abstract

Background: 82-Rubidium-Positron emission tomography myocardial perfusion imaging (Rb-PET-MPI) offers higher diagnostic performance for the detection of myocardial ischemia compared to Tc-SPECT-MPI. The aim of this economic evaluation was to perform a cost-effectiveness analysis of Rb-PET-MPI versus Tc-SPECT-MPI in patients with suspected myocardial ischemia according to pretest probabilities (PTP) of obstructive coronary artery disease based on the results of the RUBIS Trial.

Methods: Costs and effectiveness were calculated for all patients over 1 year and an incremental analysis of differences in costs and effectiveness in terms of diagnostic accuracy was performed. The uncertainty of the results was estimated using bootstrap. The analysis was conducted from the perspective of the French health care system with a time horizon of 12 months.

Results: The average cost of a Rb-PET-MPI-based strategy for the detection of myocardial ischemia was €219 lower than a SPECT-MPI-based strategy (€1192 (± 1834) vs €973 (± 1939), p < 0.01). The one-year incremental cost-effectiveness ratio was negative: - €2730 (money saved per additional accurate diagnosis) in patients presenting PTP > 15% for the Rb-PET-MPI vs. Tc-SPECT-MPI strategy. Analysis of the joint distribution of costs and outcomes found that the Rb-PET-MPI strategy had a 92% probability to be dominant (cost-saving and outcome-improving).

Conclusions: Rb-PET-MPI is cost-effective compared to Tc-SPECT-MPI for the detection of myocardial ischemia in patients with PTP > 15% of obstructive coronary artery disease.

Trial registration: RUBIS Trial registration: NCT01679886, Registered 03 September 2012, https://clinicaltrials.gov/ct2/show/NCT01679886 .

Keywords: 82-Rubidium PET; Cost-effectiveness; Myocardial perfusion imaging; Obstructive coronary artery disease; SPECT.

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Conflict of interest statement

Fabien Hyafil is Consultant for Naogen, Curium Pharma, Blue Earth Diagnostics, Novo Nordisk and shareholder of Naogen. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the economic evaluation
Fig. 2
Fig. 2
Cost of Rb-PET-MPI procedure based on the number of patients imaged per session
Fig. 3
Fig. 3
Cost-effectiveness plane: Incremental Cost-Effectiveness Ratio of Costs per additional accurate diagnosis at 12 months in each subgroup
See this image and copyright information in PMC

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