Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain

Milán Vecsey-Nagy; Tilman Emrich; Giuseppe Tremamunno; Dmitrij Kravchenko; Muhammad Taha Hagar; Gerald S Laux; U Joseph Schoepf; Jim O'Doherty; Melinda Boussoussou; Bálint Szilveszter; Pál Maurovich-Horvat; Thomas Kroencke; Ismail Mikdat Kabakus; Pal Spruill Suranyi; Akos Varga-Szemes; Josua A Decker

doi:10.1016/j.jcct.2024.10.011

Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain

J Cardiovasc Comput Tomogr. 2024 Nov 4:S1934-5925(24)00461-1. doi: 10.1016/j.jcct.2024.10.011. Online ahead of print.

Authors

Milán Vecsey-Nagy¹, Tilman Emrich², Giuseppe Tremamunno³, Dmitrij Kravchenko⁴, Muhammad Taha Hagar⁵, Gerald S Laux⁶, U Joseph Schoepf⁷, Jim O'Doherty⁸, Melinda Boussoussou⁹, Bálint Szilveszter⁹, Pál Maurovich-Horvat¹⁰, Thomas Kroencke¹⁰, Ismail Mikdat Kabakus⁷, Pal Spruill Suranyi⁷, Akos Varga-Szemes¹¹, Josua A Decker¹²

Affiliations

¹ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest 1122, Hungary.
² Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, 1 Langenbeckstraße, Mainz 55131, Germany.
³ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, 1035-1039 Via di Grottarossa, Rome 1035-1039 00189, Italy.
⁴ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 1 Venusberg-Campus, Bonn 53127, Germany.
⁵ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, 55 Hugstetter Straße, Freiburg D-79106, Germany.
⁶ Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, 1 Langenbeckstraße, Mainz 55131, Germany.
⁷ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States.
⁸ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States; Siemens Medical Solutions, 40 Liberty Boulevard, Malvern 19355, PA, United States.
⁹ Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest 1122, Hungary.
¹⁰ MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, 78a Ulloi Avenue, Budapest 1082, Hungary.
¹¹ Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston 29425, SC, United States. Electronic address: musccvi@musc.edu.
¹² Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, 2 Stenglinstraße, Augsburg 86156, Germany.

PMID: 39500702
DOI: 10.1016/j.jcct.2024.10.011

Abstract

Background: The increased specificity of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT over energy-integrating detector (EID)-CT for coronary CT angiography (CCTA) could defer unwarranted downstream tests. The objective of the study was to simulate the cost-effectiveness of UHR CCTA in stable chest pain patients with coronary calcifications.

Methods: A decision and simulation model was developed using Monte Carlo simulations with 1000 bootstrap resamples to estimate the costs associated with PCD-CT in lieu of EID-CT for CCTA and the referral for subsequent testing. The model was constructed using the diagnostic accuracy metrics of 55 coronary lesions in patients who underwent CCTA on both CT systems and subsequent invasive coronary angiography (ICA). Sensitivity and specificity were defined for each Coronary Artery Disease Reporting and Data System category. The aggregate healthcare expenditures were derived from the hospital billing system.

Results: Assuming a projected cohort of 15,000 patients over the lifetime of the PCD-CT, its implementation resulted in a 18.9 % reduction in the number of functional follow-up tests (6330.3 ± 59.5 vs. 5135.7 ± 60.6, p < 0.001), a 6.0 % reduction in performed ICAs (1447.7 ± 36.2 vs. 1360.2 ± 34.7, p < 0.001), and a 9.4 % decrease in major procedure-related complications. Over a 10-year expected life expectancy, PCD-CT led to an average cost saving of $794.50 ± 18.50 per patient and an overall cost difference of $11,917,500 ± 4,350,169.

Conclusions: PCD-CT has the potential to reduce the financial burden on healthcare systems and procedure-related complications for stable chest pain patients with coronary calcification when compared to EID-CT.

Keywords: Business in CT; Coronary computed tomography angiography; Cost-effectiveness; Financial aspect of CT; Photon-counting detector; Ultrahigh-spatial-resolution.