Evidence map›Paper›PMID 35379740›Full record

ArticleOpen heart2022

Cost-effectiveness in diagnosis of stable angina patients: a decision-analytical modelling approach.

Muhummad Sohaib Nazir, Yael Rodriguez-Guadarrama, Tiago Rua, Khan Ha Bui, Anna Buylova Gola, Amedeo Chiribiri, Paul McCrone, Sven Plein, Mark Pennington

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Open heart, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.2field-weighted citation impact, top 13% of its field
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

7 citing papers in PubMed, 15 citations in OpenAlex.

  1. Review
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  5. Observational
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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 at 4 institutions in 5 countries.

Muhummad Sohaib NazirBiomedical Engineering and Imaging Sciences, King's College London, London, UK sohaib.nazir@kcl.ac.uk.ORCID 0000-0003-2749-1033
Yael Rodriguez-GuadarramaCentre for Medical Engineering, KiTEC - King's Technology Evaluation Centre, King's College London, London, UK.
Tiago RuaBiomedical Engineering and Imaging Sciences, King's College London, London, UK.
Khan Ha BuiCentre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Anna Buylova GolaCentre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Amedeo ChiribiriBiomedical Engineering and Imaging Sciences, King's College London, London, UK.
Paul McCroneInstitute for Lifecourse Development, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK.
Sven PleinBiomedical Engineering and Imaging Sciences, King's College London, London, UK.
Mark PenningtonKing's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
King's College London · GBThe King's College · USHealth & Life (Taiwan) · TWUniversity of Leeds · GB

Funding

British Heart Foundation CH/16/2/32089Department of Health CL-2019-17-001Department of Health PB-PG-0416-20008Wellcome TrustWellcome Trust 203148/Z/16/Z
6 · The paper itself

Abstract

objectiveGiven recent data on published diagnostic accuracies, this study sought to determine the most cost-effective diagnostic strategy for detection of significant coronary artery disease (CAD) in stable angina patients using invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the reference standard.

methodsA probabilistic decision-analytical model was developed which modelled a cohort of patients with stable angina. We investigated 17 diagnostic strategies between standalone and combination of different imaging tests to establish a correct diagnosis of CAD, using no testing as the baseline reference. These tests included CT coronary angiography (CTCA), stress echocardiography, CT-based FFR, single-photon emission computed tomography (SPECT), cardiovascular magnetic resonance (CMR), positron emission tomography, ICA, and ICA with FFR. Incremental cost-effectiveness ratios were calculated as the additional cost per correct diagnosis.

resultsSPECT followed by CTCA and ICA-FFR is the most cost-effective strategy between a cost-effectiveness threshold (CET) value of £1000-£3000 per correct diagnosis. CMR followed by CTCA and ICA-FFR is cost-effective within a CET range of £3000-£17 000 per correct diagnosis. CMR and ICA-FFR is cost-effective within a CET range of £17 000-£24 000. ICA-FFR as first line is the most-cost effective if the CET value exceeds the £24 000 per correct diagnosis. Sensitivity analysis showed that direct ICA-FFR may be cost-effective in patients with a high pre-test probability of CAD.

conclusionFirst-line testing with functional imaging is cost-effective at low to intermediate value of correct diagnosis in patients with low to intermediate risk of CAD. ICA is not cost effective although ICA-FFR may be at higher CET.

Indexed as

Angina, StableCoronary Artery DiseaseFractional Flow Reserve, MyocardialCoronary AngiographyCost-Benefit AnalysisHumansCORONARY ARTERY DISEASEHealth Care Economics and OrganizationsSTABLE ANGINA

Identifiers

PMID35379740
PMCPMC8981340
OpenAlexW4224321957

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Registered trials

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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.