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Cost-effectiveness Calculator InputsCost-Effectiveness Calculator Outputs: Lifetime Per-Person Net Monetary Benefit (higher is better)
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Model input
Default US value (Ge et al 2020)
User-entered inputNo ImagingCMRCCTASPECTXCAmax NMB
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Willingness-to-pay for QALY100,000100,000 1,196,817 1,198,428 1,197,771 1,197,393 1,196,714 1,198,428
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Age in years62.562.5
*Net Monetary Benefit (NMB) is a single metric that monetizes QALYs (using willingness-to-pay) and subtracts costs
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Probability of patient having treatable CAD32.4%32.4%indicates optimal strategy based on user-entered inputs (highest net monetary benefit, equivalent to most cost-effective strategy)
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Sensitivity of CMR0.890.89
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Specificity of CMR0.870.87Cost-Effectiveness Calculator Outputs: Lifetime Discounted Per-Person QALYs (health)
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Sensitivity of CCTA0.900.90No ImagingCMRCCTASPECTXCA
max QALYs
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Specificity of CCTA0.710.7112.1604012.2039012.2035012.1959312.2038112.20390
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Sensitivity of SPECT0.730.73indicates strategy that results in highest quality-adjusted life expectancy based on user-entered inputs
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Specificity of SPECT0.830.83
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Probability patient with false negative result returns to get coronary angiography within 1 year57.59%57.59%Cost-Effectiveness Calculator Outputs: Lifetime Discounted Per-Person Costs
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Annual rate of having a new MACE event for patients without CAD 0.00640.0064No ImagingCMRCCTASPECTXCA
max costs
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Post-1st year rate of having a MACE event for patients with CAD who received revascularization procedure0.0650.065 19,223 21,962 22,578 22,199 23,667 23,667
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Hazard rate ratio for patients who received medical therapy and revascularization procedure 0.700.70indicates strategy that results in highest expected health care costs based on user-entered inputs
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Probability of dying during PCI0.1281%0.1281%
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Probability of dying during CABG0.7914%0.007914
Abbreviations and Acronyms:
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Cost of CMR 807807
CABG = coronary artery bypass grafting
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Cost of CCTA386386
CAD = coronary artery disease
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Cost of SPECT1,2191,219
CCTA = coronary computed tomographic angiography
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Cost of FFR (added to CCTA for some patients)1,4501,450
CMR = cardiovascular magnetic resonance
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Cost of immediate coronary angiography with FFR5,1755,175
CPT = current procedural terminology
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Cost of immediate coronary angiography without FFR3,0843,084
ICA = invasive coronary angiography
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Cost of CABG38,79738,797
FFR = fractional flow reserve
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Cost of PCI36,55636,556
ICER = incremental cost-effectiveness ratio
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Acute (1st-year) cost of non-fatal MACE11,12411,124
MACE = major adverse cardiovascular event(s)
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Acute (1st-year) cost of fatal MACE18,20618,206
PCI = percutaneous coronary intervention
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Utility of coronary heart disease health state0.7780.778
QALY = quality-adjusted life year
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Annual discount rate for QALYs and costs3.0%3.0%
SPECT = single-photon emission computed tomography
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XCA = x-ray coronary angiography
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Source for default (base-case) US estimates:
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Ge Y, Pandya A, Steel K, Bingham S, Abdullah S, Wang W, Chen Y, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Narang A, Farzaneh-Far A, Heitner JF, Ho JY, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Hachamovitch R, Stuber M, Simonetti OP Kwong RY. Cost Effectiveness Analysis of Stress Cardiac Magnetic Resonance Imaging for Stable Chest Pain Syndromes. JACC Cardiovasc Imaging. 2020 May 13:S1936-878X(20)30260-6.
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https://www.sciencedirect.com/science/article/pii/S1936878X20302606?via%3Dihub
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