COST MODEL FOR A NEW ACOUSTIC DIAGNOSTIC AID TO RULE OUT CORONARY ARTERY DISEASE
Author(s)
Winther S1, Böttcher M2, Wahler S3, Bolin K4
1Aarhus University Hospital, Aarhus N, Denmark, 2Hjertemedicin Hjerteforskningsklinikken, Herning, Denmark, 3St. Bernward GmbH, Hamburg, Germany, 4University of Gothenburg, Gothenburg, Sweden
OBJECTIVES: Coronary artery disease (CAD) remains the number one cause of death world-wide. Yet, diagnosis of CAD is regionally depending on traditions and reimbursement structures. Coronary sounds are a novel target to detect CAD. The economic impact of this new method was researched in the Danish health care setting, based on results of first clinical trials. This cost comparison modeled the consequences of using acoustic measures as an early rule-out test for CAD. METHODS: A decision tree model was developed based on the 2015 Danish CAD-diagnostic algorithm. It implemented the results of a prospective Danish study using an acoustic rule-out test for CAD (CADScor®System) on 228 symptomatic patients, initially referred to cardiac-CT or diagnostic catheters. Costs were derived from the 2016 Danish hospital tariff. Probabilistic sensitivity analysis (PSA) was performed. Analytic tool was MS-Excel 2016. RESULTS: Given the study population with 27.6% obstructive CAD, the first line use of acoustic testing increased the share of patients regarded very low risk from 12.7% to 30.7%, patients regarded high risk from 18.8% to 26.6%. This pretest probability adjustment led to reduction of non-contrast-CT by 39.7%, CT-angiographies by 43.1%, functional assessment by 29.0%. Slightly more diagnostic catheters were performed (+4.9%). Overall costs for diagnostics was DKK 6,096 applying acoustic testing and DKK 6,379 without; saving DKK 274 per patient. PSA confirmed the robustness of the model. CONCLUSIONS: Acoustic testing to aid early rule-out CAD in symptomatic patients has proven to decrease overall costs for diagnostic, given the Danish patient path and cost grid. Main savings resulted from reduced cardiac-CT use, in this high CAD-prevalence cohort. Saved radiation and overall cohort risk-reduction was not studied. The transferability for other diagnostic pathways and cost structures has to be tested. The results of further major clinical trials in Denmark and Germany in populations and improved algorithms may alter these findings.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
CV4
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders