YORK: Researchers from the Center for Health Economics at the University of York have analysed results from the CE-MARC study to assess the most cost effective ways to diagnose heart disease. Cost effectiveness wsa measured as the cost per life year benefit, adjusted for quality of life.

Five different strategies were tested, out of which the most cost effective two included the use of cardiac MRI (cardiac magnetic resonance, also known as CMR). These both had a better accuracy than SPECT in terms of obtaining diagnosis and suggest a greater role of cardiac MRI in assessing those with the symptoms of angina pectoris.

The second most cost effective strategy, coming in at around £30,000 per quality adjusted life year (QALY), was the use of cardiac MRI early in the diagnostic process, to be followed by cardiac angiography if the scan results are positive or inconclusive. However, the most cost effective, at £20,000 per QALY, was to administer a treadmill test, then cardiac MRI if the treadmill test is positive or inconclusive, and only then cardiac angiography if the cardiac MRI is also positive or inconclusive.

Measures of cost effectiveness take into account both the costs of the procedure and the benefits the procedure bring. Through this form of analysis it is possible to ensure that limited resources are used wisely through the establishment of normative practice guidelines. In a private healthcare setting, such studies help to avoid unnecessary costs to patients or their insurance companies.  The results of this study are reported in the journal Heart (doi:10.1136/heartjnl-2013-303624) and are based upon costs and outcomes from the United Kingdom; variation to the effectiveness of diagnostic procedures and their relative costs in other countries may limit the direct application of this study elsewhere.