Hansel J. Otero MD, Presenter: Nothing to Disclose

Frank John Rybicki MD, PhD, Abstract Co-Author: Speakers Bureau, Toshiba Corporation Advisory Board, Toshiba Corporation Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group Advisory Board, Bracco Group Advisory Board, Vital Images, Inc

Dimitris Mitsouras PhD, Abstract Co-Author: Nothing to Disclose

Leelakrishna Nallamshetty, Abstract Co-Author: Nothing to Disclose

Amanda Gray Whitmore BA, Abstract Co-Author: Nothing to Disclose

Peter J Neumann PHD, Abstract Co-Author: Nothing to Disclose

To identify all original cost-utility analyses (CUAs) in diagnostic cardiovascular imaging (CVI) and to systematically summarize reported results and characteristics of those technologies proven to be cost-effective (i.e. provide good value for the resources expended).

A systematic search of the English literature for original cost-utility studies in CVI between 2000 and 2005 was performed. Image-guided therapy studies were excluded. Studies were classified by anatomy (e.g. cerebrovascular, coronary artery disease, peripheral vascular);by imaging modality (conventional angiography, ultrasound, CT, MR, PET, SPECT); by target population (low risk, high risk, or symptomatic); and by results being favorable (incremental cost per quality-adjusted life years- QALY- below $50,000) or adverse (>$50,000 per QALY). The distribution of favorable outcomes by target population was assessed with a two-tailed 2x3 Fisher exact test.

Among the 24 CUAs, the most common vascular territory studied was cerebrovascular (n=7) followed by cardiac disease (n=5). Two-thirds (16/24) of studies focused on sonography, followed by conventional angiography (n=7), CT and MRI (n=5 for each), and SPECT and PET (n=1 each). 5 studies targeted a low-risk, 10 studies targeted high-risk, and 8 targeted symptomatic populations. Only six out of 24 cardiovascular imaging technologies had adverse cost-effective results. All (8/8) studies evaluating symptomatic patients, 78% (7/9) evaluating high-risk patients, and 43% (3/7) evaluating low-risk patients had favorable results (p=0.04). 9/10 of studies found sonography to be cost-effective (range: $520-$40,000/QALY) for peripheral vascular disease. 4/4 studies found that MRI adoption results in favorable ratios when compared to catheter-based angiography (Range: $12,000-$40,000/QALY). 2/2 studies found CT to be cost-saving for evaluation of stroke.

The 24 CUAs over the 6 year period reflect a general paucity in the literature. Those studies available have, in general, favorable cost-effectiveness profiles. A major determinant in CVI cost-effectiveness relates to the targeted population; the imaging of symptomatic and high-risk populations have significantly more favorable results than imaging low-risk populations.

 The small number of published CEA studies emphasizes the need for future investigation. The evidence does not support CVI screening studies.

Otero, H, Rybicki, F, Mitsouras, D, Nallamshetty, L, Whitmore, A, Neumann, P, Cost-effective Diagnostic Cardiovascular Imaging: When Does Imaging Provide Good Value for the Money?.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010457.html