OBJECTIVES:

With 900,000 coronary angiographies (CA) per year, Germany has the highest annual per capita volume in Europe. Because two third of these CAs are performed in patients with stable coronary artery disease (SCAD), this economic evaluation (ENLIGHT-KHK trial) evaluated the cost-effectiveness of guideline-adherent use of CA in patients with SCAD from the perspective of the German Statutory Health Insurance (SHI).

METHODS:

We developed a decision-tree based cohort and a microsimulation model for comparing major adverse cardiovascular events (MACE) and costs of real-world guideline adherence for use of CA with an (assumed) perfect guideline-adherent process. Parameters obtained from the ENLIGHT-KHK trial included non-invasive testing, CA, revascularization, potential MACE (30 days after CA) and medical costs (CA and non-invasive testing). Clinical data were based on health records, a patient questionnaire and claims data from the SHI, while costs were based on claims data only. In contrast to the cohort model, the microsimulation considered different patients’ pre-test probability for SCAD. To assess the uncertainty, deterministic and probabilistic sensitivity analyses were performed.

RESULTS:

In the base case, both models showed that perfect guideline adherence for using CA would result in a slightly lower rate of complications per person (-0.002 by both models) and less cost (-€796 in cohort and -€808 in microsimulation analysis) compared to real-world guideline adherence. Cost savings were highest for moderate pre-test probability of SCAD (€ 901), followed by low pre-test probability of SCAD (€ 502) and high pre-test probability of SCAD (€78). Sensitivity analyses confirmed the results.

CONCLUSIONS:

Our analysis suggests that improving guideline adherence for use of CA might result in cost savings for the German SHI. While both models yielded similar overall results, the microsimulation revealed that increasing guideline adherence in patients with moderate pre-test probability of SCADs has the largest cost saving potential.