Purpose: Our aim was to compare the costs-effectiveness of sequential SPECT/CCTA imaging to standard imaging in a multi-center setting.
Methods: Hospital selection (n=7) was based on the availability of detailed cost-price information and the function as tertiary center able to perform open heart surgery. In total, we retrospectively analyzed 61 420 patients who were referred to one of the selected tertiary hospitals in 2017 with stable chest pain with no prior history if CAD. Sequential SPECT/CCTA imaging was available in one hospital (11 998 patients, 19.5%) and standard care including MPI SPECT was available in the other six hospitals. The percentage of MPI SPECT scans, invasive coronary angiographies (ICA) and percutaneous coronary interventions (PCI) performed in this population were compared between the hospital offering sequential SPECT/CCTA and the other hospitals. Imaging costs were measured uniformly in all hospitals based on time-driven activity-based costing and compared between both approaches.
Results: The percentage of all patients referred for non-invasive MPI SPECT was 10.5% in the SPECT/CCTA-hospital and 5.1% in the standard hospitals. The percentage of ICA was lower in the SPECT/CCTA hospital (8.5%) than in other centers (12.0%). However, the percentage of PCIs were comparable with 7.8% vs 8.1% for the sequential and standard hospitals, respectively. The average costs spent on both invasive and non-invasive imaging was lower when offering sequential SPECT/CCTA than when only offering standard imaging (€318 vs. €339, respectively).
Conclusion: The single-day sequential SPECT/CCTA imaging approach proved cost-effective in comparison with hospitals with a conventional diagnostic approach, as it decreased the need for invasive coronary angiography. The overall cost of non-invasive imaging and the percentage of patients undergoing PCI were comparable between the two approaches.