Economic evaluation of cardiac magnetic resonance with fast-SENC in the diagnosis and management of early heart failure

John E Schneider, Ivana Stojanovic, John E Schneider, Ivana Stojanovic

Abstract

Introduction: Heart failure (HF) is a major public health concern, prevalent in millions of people worldwide. The most widely-used HF diagnostic method, echocardiography, incurs a decreased diagnostic accuracy for heart failure disease progression when patients are asymptomatic compared to those who are symptomatic. The purpose of this study is to conduct a cost-effectiveness analysis of heart failure diagnosis comparing echocardiography to a novel myocardial strain assessment (Fast-SENC), which utilizes cardiac-tagged magnetic resonance imaging.

Methods: We develop two models, one from the perspective of payers and one from the perspective of purchasers (hospitals). The payer model is a cost-effectiveness model composed of a 1-year short-term model and a lifetime horizon model. The hospital/purchaser model is a cost impact model where expected costs are calculated by multiplying cost estimates of each subcomponent by the accompanying probability.

Results: The payer model shows lower healthcare costs for Fast-SENC in comparison to ECHO ($24,647 vs. $39,097) and a lifetime savings of 37% when utilizing Fast-SENC. Similarly, the hospital model revealed that the total cost per HF patient visit is $184 for ECHO and $209 for Fast-SENC, which results in hospital contribution margins of $81 and $115, respectively.

Conclusions: Fast-SENC is associated with higher quality-adjusted life years and lower accumulated expected healthcare costs than echocardiogram patients. Fast-SENC also shows a significant short-term and lifetime cost-savings difference and a higher hospital contribution margin when compared to echocardiography. These results suggest that early discovery of heart failure with methods like Fast-SENC can be cost-effective when followed by the appropriate treatment.

Keywords: Cardiac magnetic resonance imaging; Cost-effectiveness; Heart failure; Hospital value analysis; Markov model.

Conflict of interest statement

The authors of this manuscript are full-time salaried employees of Avalon Health Economics and received no compensation specific to the production of this manuscript. The research was funded by a non-restricted grant from Myocardial Solutions, Inc., to Avalon Health Economics. The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Markov model representing HF disease progression
Fig. 2
Fig. 2
Tornado diagram presenting results of univariate sensitivity analysis. The horizontal axis shows various incremental cost-effectiveness per quality-adjusted life year. At a threshold of $50,000 per QALY, Fast-SENC strategy remains robust for all parameters

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