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

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). 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. 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. 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. Imaging of the heart and its blood vessels is typically used to diagnose coronary artery disease. Non-invasive tests have improved recently. Therefore, doctors are finding them more useful. Global clinical guidelines generally recommend that the choice of imaging test is based on whether patients have a low, intermediate, or high chance of having the disease. This chance is called a patient’s “pre-test probability.” This review compares two non-invasive tests: cardiovascular magnetic resonance (CMR) imaging and myocardial perfusion scintigraphy by single photon emission computed tomography (MPS-SPECT). We looked at which of these tests is better value for money from a payer’s perspective. Thirteen studies in this review compared CMR and MPS-SPECT. The studies were published between 2007 and 2022. CMR was always better value for money than MPS-SPECT for patients with a low or intermediate pre-test probability in the USA and Germany. In the USA, CMR also reduced the need for additional healthcare resource expenses. In the UK, CMR was sometimes better value for money than MPS-SPECT for patients with a low, intermediate, or high pre-test probability. Overall, this review supports CMR as a better value for money option than MPS-SPECT when diagnosing patients with a low or intermediate chance of having coronary artery disease. This should be considered by healthcare providers and funders when reimbursement and investment decisions are being made. However, we only found a small number of studies, so more research is needed.