Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography.

To estimate the cost-effectiveness of early CT coronary angiography (CTCA) for intermediate risk patients with suspected acute coronary syndrome (ACS), compared with standard care METHODS: We performed within-trial economic analysis using data from the RAPID-CTCA randomised trial, and long-term modelling of cost-effectiveness using secondary data sources to estimate the cost-effectiveness of early CTCA compared with standard care for patients with suspected ACS attending acute hospitals in the UK. Cost-effectiveness was estimated as the incremental cost per quality-adjusted life year (QALY) gained, and the probability of each strategy being cost-effective at varying willingness-to-pay per QALY gained. The within-trial analysis showed that there were no demonstrable differences in costs or QALYs between early CTCA and standard care, with point estimates suggesting higher costs (£7414 vs £6845: mean difference £569, 95% CI -£208 to £1335; p=0.1521) and lower QALYs (0.749 vs 0.758, mean difference -0.009, 95% CI -0.026 to 0.010; p=0.377) in the CTCA arm. The long-term economic analysis suggested that, on average, CTCA was slightly less effective than standard care alone with 0.025 quality-adjusted life years lost per patient treated and was more expensive with additional costs of £481 per patient treated. At a threshold of £20 000 per QALY, CTCA has 24% probability of being cost-effective. There are no demonstrable differences in within-trial costs and QALYs, and long-term cost-effectiveness modelling suggested higher long-term costs with CTCA and uncertain effect on long-term QALYs, making routine use of CTCA for suspected ACS unlikely to be a cost-effective use of NHS resources.

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Déclaration de conflit d'intérêts

Competing interests: AG is a member of the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) Prioritisation Committee. SG is the chairperson of the NIHR CTU Standing Advisory Committee. He was the deputy director of the NIHR HTA programme; chairperson of the NIHR HTA Commissioning Committee and a member of the HTA Post-Funding Committee, HTA Funding Committee Policy Group and HTA Programme Oversight Committee. DEN is a Deputy Editor for BMJ Heart. He also reports unrestricted educational grants from Siemens Healthineers (Erlangen, Germany).