Evidence map›Paper›PMID 31300495›Full record

ArticleBMJ open2019

Cardiovascular magnetic resonance in emergency patients with multivessel disease or unobstructed coronary arteries: a cost-effectiveness analysis in the UK.

Elizabeth A Stokes, Brett Doble, Maria Pufulete, Barnaby C Reeves, Chiara Bucciarelli-Ducci, Stephen Dorman, John P Greenwood, Richard A Anderson, Sarah Wordsworth

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Elizabeth A StokesHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.ORCID 0000-0002-4179-1369
Brett DobleHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.ORCID 0000-0002-4948-8831
Maria PufuleteClinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.ORCID 0000-0002-1775-1949
Barnaby C ReevesClinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.ORCID 0000-0002-5101-9487
Chiara Bucciarelli-DucciNIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Stephen DormanBristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
John P GreenwoodLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Richard A AndersonUniversity Hospital of Wales, Cardiff, UK.
Sarah WordsworthHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Funding

Department of Health 11/2003/58
6 · The paper itself

Abstract

objectiveTo identify the key drivers of cost-effectiveness for cardiovascular magnetic resonance (CMR) when patients activate the primary percutaneous coronary intervention (PPCI) pathway.

designEconomic decision models for two patient subgroups populated from secondary sources, each with a 1 year time horizon from the perspective of the National Health Service (NHS) and personal social services in the UK.

settingUsual care (with or without CMR) in the NHS.

participantsPatients who activated the PPCI pathway, and for Model 1: underwent an emergency coronary angiogram and PPCI, and were found to have multivessel coronary artery disease. For Model 2: underwent an emergency coronary angiogram and were found to have unobstructed coronary arteries.

interventionsModel 1 (multivessel disease) compared two different ischaemia testing methods, CMR or fractional flow reserve (FFR), versus stress echocardiography. Model 2 (unobstructed arteries) compared CMR with standard echocardiography versus standard echocardiography alone.

main outcome measuresKey drivers of cost-effectiveness for CMR, incremental costs and quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios.

resultsIn both models, the incremental costs and QALYs between CMR (or FFR, Model 1) versus no CMR (stress echocardiography, Model 1 and standard echocardiography, Model 2) were small (CMR: -£64 (95% CI -£232 to £187)/FFR: £360 (95% CI -£116 to £844) and CMR/FFR: 0.0012 QALYs (95% CI -0.0076 to 0.0093)) and (£98 (95% CI -£199 to £488) and 0.0005 QALYs (95% CI -0.0050 to 0.0077)), respectively. The diagnostic accuracy of the tests was the key driver of cost-effectiveness for both patient groups.

conclusionsIf CMR were introduced for all subgroups of patients who activate the PPCI pathway, it is likely that diagnostic accuracy would be a key determinant of its cost-effectiveness. Further research is needed to definitively answer whether revascularisation guided by CMR or FFR leads to different clinical outcomes in acute coronary syndrome patients with multivessel disease.

Indexed as

Cost-Benefit AnalysisAdultAgedCoronary AngiographyCoronary Artery DiseaseDecision TreesEchocardiographyEmergency Service, HospitalFemaleHumansMagnetic Resonance AngiographyMaleMiddle AgedModels, EconomicPercutaneous Coronary InterventionQuality-Adjusted Life Yearscardiovascular diseasecardiovascular magnetic resonancecost-utility analysisdiagnostic accuracyeconomic evaluationmyocardial infarction

Identifiers

PMID31300495
PMCPMC6629389

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.