OBJECTIVES: Coronary artery disease (CAD) is a growing health problem in the United States (U.S.) and presents significant clinical and economic burden to patients and healthcare systems. Nuclear-based myocardial perfusion imaging (MPI) modalities, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are clinically indicated for CAD diagnosis in individuals with an intermediate pre-test probability for CAD. While SPECT has diagnostic challenges, PET has emerged as a compelling alternative due to enhanced image quality and refined attenuation correction. This study assessed the affordability of PET with a novel radiotracer compared to SPECT for CAD diagnosis from a U.S. payer perspective.

METHODS: A budget impact model was developed with a 5-year time horizon. Four suspected CAD analysis populations (general, women, body mass index [BMI] >30kg/m², and diabetes) were selected based on appropriate use criteria guidelines and difficulty in realizing a SPECT efficiently. In brief, the model linked diagnostic performance to downstream outcomes (i.e., healthcare resource utilization [HCRU] and cardiac events) and used coverage payment codes to quantify MPI modality costs. The budget impact was measured through a comparison of two hypothetical scenarios: 1) a world without PET with a novel radiotracer and 2) a world with PET with a novel radiotracer. Results are reported as incremental per member per month (PMPM) costs.

RESULTS: The 5-year average PMPM net budget impact is -$0.21, -$0.10, -$0.11, and -$0.14, for general, women, BMI>30kg/m², and diabetes populations, respectively, indicating cost-savings in the world with PET with a novel radiotracer. Annual cost-savings were also observed in all populations. Savings resulted from reductions in HCRU (e.g., revascularization procedures).

CONCLUSIONS: This comprehensive analysis illustrates that the adoption of PET with a novel radiotracer with increased diagnostic performance demonstrates economic benefits compared to SPECT for CAD diagnosis. These findings can be used to inform U.S. healthcare decision makers.