Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography

Objectives To estimate the cost-effectiveness of early CT coronary angiography (CTCA) for intermediate risk patients with suspected acute coronary syndrome (ACS), compared to standard care
Methods We performed within-trial economic analysis using data from the RAPID-CTCA randomised trial, and long-term modelling of cost-effectiveness using secondary data sources to estimate the cost-effectiveness of early CTCA compared with standard care for patients with suspected ACS attending acute hospitals in the UK.
Cost-effectiveness was estimated as the incremental cost per quality-adjusted life year (QALY) gained, and the probability of each strategy being cost-effective at varying willingness-to-pay per QALY gained.
Results The within-trial analysis showed that there was no demonstrable differences in costs or QALYs between early CTCA and standard care, with point estimates suggesting higher costs (£7,414 versus £6,845: mean difference £569, 95% confidence interval, -£208 to £1335; p=0.1521) and lower QALYs (0.749 versus 0.758, mean difference -0.009, 95% CI -0.026 to 0.010; p=0.377) in the CTCA arm. The long-term economic analysis suggested that, on average, CTCA was slightly less effective than standard care alone with 0.025 quality adjusted life years lost per patient treated and was more expensive with additional costs of £481 per patient treated. At a threshold of £20,000 per QALY, CTCA has 24% probability of being cost-effective.
Conclusions There are no demonstrable differences in within-trial costs and QALYs, and long-term cost-effectiveness modelling suggested higher long-term costs with CTCA and uncertain effect on long-term QALYs, making routine use of CTCA for suspected acute coronary syndrome unlikely to be a cost-effective use of NHS resources.