When treating low-risk stable chest pain, what’s the most cost-effective imaging option?

When patients present with low-risk stable chest pain (SCP), anatomic imaging strategies—coronary computed tomography angiography (CTA), for example—may be more cost-effective than functional strategies, according to new research published in JAMA Network Open.

The authors developed a microsimulation model to investigate, relying on patient data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. The PROMISE Trial, funded by the National Heart, Lung, and Blood Institute, was originally completed in February 2016.

The team’s final microsimulation model included information from more than 10,000 patients. Turning to an anatomic approach when treating patients with low-risk SCP led to higher invasive coronary angiography (ICA) and revascularization rates after 60 days, two years and five years. This trend “appeared to be driven by the higher sensitivity of anatomic testing to detect coronary artery disease (CAD).”

Overall, anatomic imaging approaches were found to be both “less costly” and “more effective.” Over a patient’s lifetime, they were also associated with a much higher number of quality-adjusted life-years.

“The results of our analysis, using a Markov model incorporating individual patient-level data from PROMISE, suggest that anatomic approaches are cost-effective compared with functional testing across a wide range of assumptions in clinical care and patient characteristics, mostly because of a higher sensitivity to detect nonobstructive and obstructive CAD and the ability to tailor statin therapy accordingly,” wrote lead author Júlia Karády, MD, Massachusetts General Hospital in Boston, and colleagues.

The full analysis is available here.