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dc.contributor.authorKozor, Rebecca
dc.contributor.authorWalker, Simon
dc.contributor.authorParkinson, Bonny
dc.contributor.authorYounger, John
dc.contributor.authorHamilton-Craig, Christian
dc.contributor.authorSelvanayagam, Joseph B
dc.contributor.authorGreenwood, John P
dc.contributor.authorTaylor, Andrew J
dc.date.accessioned2020-09-06T22:40:56Z
dc.date.available2020-09-06T22:40:56Z
dc.date.issued2020
dc.identifier.issn1443-9506
dc.identifier.doi10.1016/j.hlc.2020.07.008
dc.identifier.urihttp://hdl.handle.net/10072/397103
dc.description.abstractBACKGROUND: Coronary artery disease (CAD) remains a major public health problem in Australia and globally. A variety of imaging techniques allow for both anatomical and functional assessment of CAD and selection of the optimal investigation pathway is challenging. Cardiovascular magnetic resonance (CMR) is not widely used in Australia, partly due to perceived cost and lack of Federal Government reimbursement compared to the alternative techniques. The aim of this study was to estimate the cost-effectiveness of different diagnostic strategies in identifying significant CAD in patients with chest pain suggestive of angina using the evidence gathered in the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC trial), analysed from the Australian health care perspective. METHODS: A decision analytic model coupled with three distinct Markov models allowed eight potential clinical investigation strategies to be considered; combinations of exercise electrocardiogram stress testing (EST), single-photon emission computed tomography (SPECT), stress CMR, and invasive coronary angiography (ICA). Costs were from the Australian health care system in Australian dollars, and outcomes were measured in terms of quality-adjusted life-years. Parameter estimates were derived from the CE-MARC and EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease (EUROPA) trials, and from reviews of the published literature. RESULTS: The most cost-effective diagnostic strategy, based on a cost-effectiveness threshold of $45,000 to $75,000 per QALY gained, was EST, followed by stress CMR if the EST was positive or inconclusive, followed by ICA if the stress CMR was positive or inconclusive; this held true in the base case and the majority of scenario analyses. CONCLUSIONS: This economic evaluation shows that an investigative strategy of stress CMR if EST is inconclusive or positive is the most cost-effective approach for diagnosing significant coronary disease in chest pain patients within the Australian health care system.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherElsevier
dc.relation.ispartofjournalHeart Lung Circ
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.fieldofresearchHealth services and systems
dc.subject.fieldofresearchPublic health
dc.subject.fieldofresearchcode3201
dc.subject.fieldofresearchcode4203
dc.subject.fieldofresearchcode4206
dc.subject.keywordsCardiovascular magnetic resonance
dc.subject.keywordsCoronary heart disease
dc.subject.keywordsCost-effectiveness
dc.subject.keywordsStress perfusion
dc.titleCost-Effectiveness of Cardiovascular Magnetic Resonance in Diagnosing Coronary Artery Disease in the Australian Health Care System
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationKozor, R; Walker, S; Parkinson, B; Younger, J; Hamilton-Craig, C; Selvanayagam, JB; Greenwood, JP; Taylor, AJ, Cost-Effectiveness of Cardiovascular Magnetic Resonance in Diagnosing Coronary Artery Disease in the Australian Health Care System., Heart Lung Circ, 2020
dcterms.dateAccepted2020-07-06
dc.date.updated2020-09-03T03:34:34Z
gro.description.notepublicThis publication has been entered in Griffith Research Online as an advanced online version.
gro.hasfulltextNo Full Text
gro.griffith.authorHamilton-Craig, Christian


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