Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

Eur Radiol. 2007 May;17(5):1301-9. doi: 10.1007/s00330-006-0439-3. Epub 2006 Oct 10.


We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of euro4,435 (10% likelihood) to euro1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Calcinosis / diagnosis*
  • Calcinosis / diagnostic imaging
  • Calcinosis / economics
  • Coronary Angiography / economics*
  • Coronary Disease / diagnosis*
  • Coronary Disease / economics
  • Cost-Benefit Analysis
  • Decision Trees
  • Echocardiography, Stress / economics
  • Electrocardiography / economics
  • Female
  • Humans
  • Magnetic Resonance Imaging / economics*
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / economics*