1334156 - Cost Effectiveness Analysis in CMR with a Focus on Coronary Artery Disease

Background: While CMR can be a highly accurate test for many myocardial pathologies, it's widespread adoption is limited due to exam duration, cost, discomfort for the patient, and safety. Other cheaper and faster diagnostic modalities are often used to acquire preliminary information before justifying the use of CMR. The aim of this educational poster was to highlight the diagnostic and prognostic value of CMR in the strictest context of its cost-effectiveness in the long run.

Methods: We selected seventeen articles after searching the PubMed MEDLINE database. The inclusion criteria required studies to have data utilizing cost-effectiveness analysis, or lack thereof in the use of CMR. Studies were excluded if they were qualitative descriptive studies, written in non-English, or had redundant data. There were no restrictions on gender, age, and cardiac pathologies.

Results: In the long run, CMR becomes the most cost-effective test at certain thresholds of pre-test probabilities for CAD and also among patients with suspected prior myocardial infarction where there is a question of intervention/revascularization. In one of the largest dataset analyses using the Stress CMR Perfusion Imaging in the United States (SPINS) registry, a CMR-based assessment was the most cost-effective in patients with a 32.4% probability of obstructive CAD prior to invasive coronary angiography based on the $100,000 per quality-adjusted life year (QALY) threshold in the United States. Several studies revealed CMR to be more effective at a lower pre-test probability (< 60%), although this finding can vary greatly between studies. In addition, multiple patient factors, demographics, geographic locations, insurance, and institutional policies significantly alter the costs of CMR. Diagnostic accuracy of CMR may also influence its costs, with changing costs based on the sensitivity and specificity of a particular test. Interestingly, a unique combination of imaging strategies may be more cost-effective under certain situations.

Conclusion: As suggested by various cost-effective studies, CMR has the potential to be utilized at greater length in diagnosing and confirming cardiac conditions including infarct and ischemia, myocarditis, infiltrative, and other cardiomyopathies to name a few. While the monetary and time investment will initially require adjustment, the improvement in diagnosis and QALY added for patients under specific circumstances could make CMR a more cost-effective diagnostic tool in the long run, especially when the analysis is done to adjust for downstream comorbidities and mortality of missed diagnoses. Despite its great promise, there are some limitations to the use of CMR in the community. Reimbursement patterns can vary significantly based on geographic location, timeline, and changes in professional society’s guidelines. With further progress in the field, its widespread routine use in numerous cardiac pathologies across various healthcare settings/systems is expected in the near future.