Cost-effectiveness of CMR over MPS-SPECT: a systematic review of recent trends for diagnosing CAD.

Aims: The health economic impacts of cardiovascular magnetic resonance (CMR) imaging and myocardial perfusion scintigraphy by single photon emission computed tomography (MPS-SPECT) as diagnostic modalities are not well understood. This review is based on a wider systematic review and aims to compare CMR and MPS-SPECT as first-line, non-invasive modalities for the diagnosis of symptomatic individuals with a low-to-intermediate pre-test probability (PTP) of coronary artery disease (CAD).

Materials and methods: We performed a systematic review of MEDLINE and Embase, MEDLINE In-process, the Cochrane Database of Systematic reviews and the Cochrane Central Register of Controlled Trials. Studies from January 1992 to January 2023 were included, if they were based in the UK, France, Germany, Italy, Japan, China, and/or the USA (published in any language). Risk of bias was assessed using the Drummond checklist.

Results: Thirteen relevant reports were identified. In the USA, CMR was consistently cost-effective compared with MPS-SPECT for patients with a low-to-intermediate PTP of CAD; resource use and associated costs, as well as total costs, were lower. For patients with a low-to-intermediate PTP of CAD in Europe, CMR was cost-effective in Germany, while in the UK increases in quality-adjusted life-years were found but cost savings were mixed. This review found only 13 reports on the economic benefits of CMR over MPS-SPECT, with just three providing cost-effectiveness outcomes, highlighting the need for further research across different settings and perspectives.

Conclusion: Overall, findings suggest that the cost savings from using CMR compared with MPS-SPECT for patients with a low-to-intermediate PTP of CAD support prioritized investment; however, confirmatory research is needed given the limited number of cost-effectiveness analyses identified in this review.