Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis
Background Transthyretin cardiac amyloidosis (ATTR‐CMP) is an increasingly recognized and treatable cause of heart failure with preserved ejection fraction. Multimodality cardiac imaging is recommended for ATTR‐CMP diagnosis, but its cost‐effectiveness in current clinical practice has not been well...
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| Format: | Article |
| Language: | English |
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Wiley
2022-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.026308 |
| _version_ | 1827976878377402368 |
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| author | Yin Ge Ankur Pandya Sarah A. M. Cuddy Amitoj Singh Avinainder Singh Sharmila Dorbala |
| author_facet | Yin Ge Ankur Pandya Sarah A. M. Cuddy Amitoj Singh Avinainder Singh Sharmila Dorbala |
| author_sort | Yin Ge |
| collection | DOAJ |
| description | Background Transthyretin cardiac amyloidosis (ATTR‐CMP) is an increasingly recognized and treatable cause of heart failure with preserved ejection fraction. Multimodality cardiac imaging is recommended for ATTR‐CMP diagnosis, but its cost‐effectiveness in current clinical practice has not been well studied. Methods and Results Using a microsimulation model, we compared the cost‐effectiveness of a combination of strategies involving 99mtechnetium pyrophosphate (PYP), cardiac magnetic resonance imaging, and endomyocardial biopsy for the diagnosis of ATTR‐CMP. We developed a decision analytic model to project health care costs and lifetime quality‐adjusted life years for symptomatic, older patients who present with congestive heart failure, with an increased left ventricular wall thickness and a 13% prevalence of ATTR‐CMP. Rates of clinical events, costs, and quality‐of‐life values were estimated from published literature. The analysis was conducted from a US health care system perspective with health and cost outcomes discounted annually at 3%. In the base‐case scenario, using a fixed tafamidis price of $16 000 annually (previously identified cost‐effective price), total health care costs per person were lowest for the PYP‐only strategy ($209 415) and highest for endomyocardial biopsy strategy ($215 881). Of the 7 strategies examined, the PYP‐only strategy had the highest net monetary benefit using a willingness‐to‐pay threshold of $100 000/quality‐adjusted life year. Results were sensitive to variations in model inputs for PYP and cardiac magnetic resonance imaging specificity, cost of tafamidis, and willingness‐to‐pay thresholds. Conclusions Our model‐based analyses showed that a PYP‐only strategy to diagnose ATTR‐CMP is the most cost‐effective strategy, at willingness‐to‐pay threshold of $100 000/quality‐adjusted life year. At higher threshold ($150 000/quality‐adjusted life year), sequential tests involving PYP and cardiac magnetic resonance imaging may be considered cost effective. |
| first_indexed | 2024-04-09T20:56:32Z |
| format | Article |
| id | doaj.art-871939606f6647d4b2a6c218b398966b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T20:56:32Z |
| publishDate | 2022-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-871939606f6647d4b2a6c218b398966b2023-03-29T18:38:57ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-09-01111810.1161/JAHA.122.026308Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac AmyloidosisYin Ge0Ankur Pandya1Sarah A. M. Cuddy2Amitoj Singh3Avinainder Singh4Sharmila Dorbala5Division of Cardiology, Department of Medicine St. Michael’s Hospital, University of Toronto Toronto CanadaDepartment of Health Policy and Management Harvard T.H. Chan School of Public Health Boston MAAmyloidosis Program, Division of Cardiology, Department of Medicine Brigham and Women’s Hospital Boston MASarver Heart Center, Division of Cardiology, Department of Medicine University of Arizona, Tucson (Banner University Medical Center) Tucson AZCardiovascular Division, Department of Medicine Brigham and Women’s Hospital Boston MAAmyloidosis Program, Division of Cardiology, Department of Medicine Brigham and Women’s Hospital Boston MABackground Transthyretin cardiac amyloidosis (ATTR‐CMP) is an increasingly recognized and treatable cause of heart failure with preserved ejection fraction. Multimodality cardiac imaging is recommended for ATTR‐CMP diagnosis, but its cost‐effectiveness in current clinical practice has not been well studied. Methods and Results Using a microsimulation model, we compared the cost‐effectiveness of a combination of strategies involving 99mtechnetium pyrophosphate (PYP), cardiac magnetic resonance imaging, and endomyocardial biopsy for the diagnosis of ATTR‐CMP. We developed a decision analytic model to project health care costs and lifetime quality‐adjusted life years for symptomatic, older patients who present with congestive heart failure, with an increased left ventricular wall thickness and a 13% prevalence of ATTR‐CMP. Rates of clinical events, costs, and quality‐of‐life values were estimated from published literature. The analysis was conducted from a US health care system perspective with health and cost outcomes discounted annually at 3%. In the base‐case scenario, using a fixed tafamidis price of $16 000 annually (previously identified cost‐effective price), total health care costs per person were lowest for the PYP‐only strategy ($209 415) and highest for endomyocardial biopsy strategy ($215 881). Of the 7 strategies examined, the PYP‐only strategy had the highest net monetary benefit using a willingness‐to‐pay threshold of $100 000/quality‐adjusted life year. Results were sensitive to variations in model inputs for PYP and cardiac magnetic resonance imaging specificity, cost of tafamidis, and willingness‐to‐pay thresholds. Conclusions Our model‐based analyses showed that a PYP‐only strategy to diagnose ATTR‐CMP is the most cost‐effective strategy, at willingness‐to‐pay threshold of $100 000/quality‐adjusted life year. At higher threshold ($150 000/quality‐adjusted life year), sequential tests involving PYP and cardiac magnetic resonance imaging may be considered cost effective.https://www.ahajournals.org/doi/10.1161/JAHA.122.026308cardiac amyloidosiscost–benefit analysismultimodal imaging |
| spellingShingle | Yin Ge Ankur Pandya Sarah A. M. Cuddy Amitoj Singh Avinainder Singh Sharmila Dorbala Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac amyloidosis cost–benefit analysis multimodal imaging |
| title | Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis |
| title_full | Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis |
| title_fullStr | Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis |
| title_full_unstemmed | Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis |
| title_short | Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis |
| title_sort | modeling the cost and health impacts of diagnostic strategies in patients with suspected transthyretin cardiac amyloidosis |
| topic | cardiac amyloidosis cost–benefit analysis multimodal imaging |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.026308 |
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