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KCE Reports 82 Multislice CT in Coronary Heart Disease 79
Perspective
Target population
The perspective taken is that of the Belgian health care payer, including both the
National Institute for Health and Disability Insurance (RIZIV/INAMI) and the patients.
For the calculation of the costs of the two diagnostic work-up arms, we calculate the
total reimbursement by the RIZIV/INAMI and add, if applicable, the patients’ out-ofpocket
expenses.
The target population of our model is as in the RCT: adult patients with acute chest
pain who are deemed at low risk for coronary events after and initial work-up in the
emergency department (ECG, biomarkers).
Population characteristics in both groups are presented in Table 20:
Table 20: Patient characteristics in the two diagnostic groups
MSCT Group Standard of Care group P-value
N=99
N=98
Age, mean in yrs 47 50 0.08
Male, % 43 57 0.05
Body Mass Index 28 28 0.78
Hypertension, % 39 38 0.88
Diabetes, % 8.2 12.2 0.35
Family history of early coronary disease,
%
40 44 0.56
Current smoker, %
Goldman Riley criteria, %
15 20 0.35
0 very low risk
100
99 1
1 low risk
0
1
2 moderate risk
Source: Goldstein et al.
0
0
67
Comparator
Costs
The comparator to MSCT angiography is ”standard of care” as defined by Goldstein et
al. (2007). This includes noninvasive coronary tests, i.e. serial electrocardiograms and
cardiac biomarkers at 0, at 4 and at 8 hours and rest-stress MPS. Common procedures
to both diagnostic arms were the electrocardiograms and cardiac biomarkers at 0 and
at 4 hours. Patients were randomised if both of these were normal. Therefore, the
difference in primary diagnostic protocol between the ”intervention”, i.e. MSCT, and
the comparator, i.e. ”standard of care”, is one cardiac biomarker and SPECT as part of
the initial diagnostic strategy in the ”standard of care” group.
According to the Belgian pharmacoeconomic guidelines only included direct health care
costs should be included in the base-case cost analysis. Indirect costs of productivity
losses were not included.
Initial diagnostic strategy
The costs of the initial diagnostic strategy were calculated on the basis of the prevailing
reimbursement tariffs and out-of-pocket expenses of the procedures associated with
the strategy.
For MSCT angiography no reimbursement tariff exists (yet). Therefore, we used the
reimbursement and patients’ out-of-pocket expenses for „chest CT“, which are the
tariffs actually applied for MSCT. Usually other costs are associated with procedures
than the costs of the procedure itself. For example, when a patient enters an emergency
department and gets a MSCT angiography after which he is immediately discharged, the
hospital can charge other costs to the RIZIV/INAMI such as a physician’s fee.