Cost Differences in CTA, Functional Diagnostic Testing for CAD

CT angiography (CTA) and functional diagnostic testing strategies in patients with suspected coronary artery disease (CAD) have similar costs, according to a study published in the Annals of Internal Medicine.

Researchers from Duke University in Durham, NC, Harvard Medical School in Boston, MA, and the National Heart, Lung, and Blood Institute in Bethesda, MD, conducted prospective economic analysis for PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain).

A total of 9,649 patients were enrolled in PROMISE between July 2010 and September 2013, and the median follow-up was 25 months. The researchers estimated technical costs of the outpatient testing strategy using the Premier Research Database; hospital-based costs were

estimated using hospital bills and Medicare cost–charge ratios; and physician fees were taken from the Medicare Physician Fee Schedule.

Mean initial testing costs were:

• Exercise electrocardiography: $174

• CTA: $404

• Pharmacologic and exercise stress echocardiography: $501 to $514, respectively

• Exercise and pharmacologic stress nuclear testing: $946 to $1,132, respectively

The mean costs at 90 days were $2,494 for the CTA strategy versus $2,240 for the functional strategy. The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use, the researchers noted. After 90 days, the mean cost difference between the groups out to three years remained small.

The researchers concluded that CTA and functional diagnostic testing strategies in patients with suspected CAD have similar costs through three years of follow-up.