Cost-effectiveness of magnetic resonance imaging in coronary heart disease: an economic evaluation using data from the CE-MARC study

Methods Design: Cost-effectiveness analysis using a decision analytic model to compare eight strategies for the diagnosis of CHD. Outcomes are expressed in terms of qualityadjusted life-years (QALYs) and costs are assessed from the perspective of the UK National Health Service (NHS). Population: Patients referred to cardiologists for the further evaluation of symptoms thought to be angina pectoris. Base case characteristics were based upon the CE-MARC study. Interventions: Eight different strategies were considered: 1. CA only. 2. ETT, followed by CA if ETT is positive or inconclusive. 3. ETT, followed by CMR if ETT is positive or inconclusive, followed by CA if the CMR is positive or inconclusive 4. ETT, followed by SPECT if ETT is positive or inconclusive, followed by CA if the SPECT is positive or inconclusive 5. CMR, followed by CA if CMR is positive or inconclusive 6. SPECT, followed by CA if SPECT is positive or inconclusive 7. ETT, followed by CA if positive, or followed by CMR if ETT is inconclusive, followed by CA if CMR is positive or inconclusive 8. ETT, followed by CA if positive, or followed by SPECT if ETT is inconclusive, followed by CA if SPECT is positive or inconclusive. Main outcome measures: Costs expressed as UK sterling in 2010/11 prices and health outcomes in quality-adjusted life-years (QALYs). The time horizon was 50 years.