Assessing the value of coronary artery computed tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected coronary artery disease. Economic outcomes of the CAT-CAD randomized trial

Abstract Background Clinical and safety outcomes of the strategy employing coronary computed tomography angiography (CCTA) as the first-choice imaging test in this population have been recently shown in the published CAT-CAD randomized, prospective, single-center study. Based on prospectively collected data we aimed to evaluate economic outcomes and cost-effectiveness of such innovative approach. Methods 120 participants of the CAT-CAD trial (age:60.6 ± 7.9 years, 35% female) were included in the economic analysis. During the diagnostic and therapeutic period we counted crucial medical resources. We prospectively estimated the cumulative cost for each strategy by multiplying the number of resources by standardized costs with accordance to medical database and 2015 Procedural Reimbursement Payment Guide. Results The total cost of coronary artery disease (CAD) diagnosis was significantly lower in the CCTA group as compared to the direct invasive coronary angiography (ICA) group ($50,176 vs $137,032) with corresponding per-patient cost of $836 vs $2,284, respectively. Similarly, the entire diagnostic and therapeutic course was significantly less expensive in the CCTA group ($227,622 vs $502,827) with corresponding per-patient cost of $4,630 vs $8,380, respectively. Overall, the application of CCTA as the first-line diagnostic test in stable patients with indications to ICA resulted in 63% reduction of CAD diagnosis costs and 55% reduction of the composite of diagnosis and treatment costs. Conclusions Application of CCTA as the first-line anatomic test in patients with suspected significant CAD decreased the total costs of diagnosis. This benefit can be achieved by reducing the number of invasive tests and hospitalisations. Economic analysis of the CAT-CAD randomized trial suggests that this approach is cost-effective and may provide significant cost savings for the entire health systems.