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86 Multislice CT in Coronary Heart Disease KCE Reports 82
As far as the limited duration of the trial, and consequently the economic model, is
concerned, we know from the clinical literature review that the prognosis of patients
who present with atypical chest pain is generally good. Early intervention in patients
with CAD but no documented ischemia diagnosed by MSCT angiography does not
necessarily improve long-term outcomes in these patients.
The cost estimates in our base-case analysis only included direct health care costs.
Indirect costs from productivity losses were not valued. In the RCT, more patients in
the MSCT arm underwent revascularisation than in the standard of care arm.
Revascularisation requires hospitalisation for, on average, 3 to 7 (PCI) or 13 to 18
(CABG) days in Belgium.(https://tct.fgov.be/etct/anonymous?lang=nl; visited on April 10,
2008) This would imply higher indirect costs associated with MSCT. As it was already
clear from the direct cost calculation that MSCT is more expensive than standard of
care, indirect costs would only add to the cost difference between MSCT and standard
of care. This is a qualitative conclusion that can be drawn, without having to quantify the
precise impact on productivity.