{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:44:49Z","timestamp":1785188689101,"version":"3.55.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T00:00:00Z","timestamp":1748044800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T00:00:00Z","timestamp":1748044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Computed tomography (CT) is as safe as invasive coronary angiography (ICA) in the incidence of major adverse cardiovascular events in patients with atypical chest pain. However, the cost-utility of CT and ICA in healthcare after long-term follow-up is still unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prespecified cost-utility analysis (CUA)\u00a0of 329 patients with atypical chest pain from a single-centre randomised trial compared CT and ICA. The CUA was conducted from the health sector perspective up to a 3-year follow-up using quality-adjusted life years (QALYs) from the EQ-5D-3L questionnaire. Costs were obtained from each individual\u2019s outpatient and inpatient billing data and included cardiovascular medications, hospitalisations, emergency visits, cardiologist visits, and cardiac examinations. The analysis implemented 500 multiple imputations and 1000 bootstrapping iterations per imputed dataset, followed by calculating the net monetary benefit (NMB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was no significant difference in mean QALYs at either 1-year (CT: 0.69 (95% CI: 0.66\u20130.72); ICA: 0.71 (95% CI: 0.68\u20130.74); difference: \u22120.02 (\u22120.06 to 0.03)) or 3-year follow-up (CT: 2.09 (95% CI: 2.00\u20132.17); ICA: 2.11 (95% CI: 2.02\u20132.19); difference: \u22120.02 (95% CI: \u22120.14 to 0.12)), while the mean cost per patient was significantly lower in the CT compared with the ICA at both 1-year (difference (\u20ac): \u22121647.8, 95% CI: \u22122198.3 to 1093.3) and at 3-year follow-ups (difference (\u20ac): \u22121543.3, 95% CI: \u22122228.0 to \u2212830.0). At a willingness-to-pay of \u20ac20,000\/QALY, the mean incremental NMB of CT over ICA was \u20ac1256.5 (164.8\u20132331.8) at 1-year and \u20ac1202.0 (95% CI: \u22121378.7 to \u22123961) at 3-year follow-ups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A CT-first strategy for the management of patients with atypical angina or chest pain was more cost-effective than a direct ICA strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT00844220.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>What is the cost-effectiveness of using CT compared to invasive coronary angiography (ICA) for diagnosing coronary artery disease in patients with atypical chest pain?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>A CT-first diagnostic strategy was \u20ac1543 less costly per patient over a 3-year follow-up, yielding similar quality-adjusted life years compared to ICA.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>CT offers a cost-effective, non-invasive alternative to ICA for patients with atypical chest pain, reducing healthcare costs significantly without compromising patient-reported outcomes or quality of life.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11692-0","type":"journal-article","created":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T04:34:55Z","timestamp":1748061295000},"page":"6719-6734","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-utility of computed tomography in patients with atypical chest pain clinically referred for invasive coronary angiography: randomised controlled trial"],"prefix":"10.1007","volume":"35","author":[{"given":"Maria","family":"Bosserdt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3077-5427","authenticated-orcid":false,"given":"Mahmoud","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Rieckmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henryk","family":"Dreger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Brodszky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"H\u00f6fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Reinhold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Maria","family":"Mielke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Dewey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,24]]},"reference":[{"key":"11692_CR1","first-page":"11945","volume":"365","author":"R Haase","year":"2019","unstructured":"Haase R, Schlattmann P, Gueret P et al (2019) Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. 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N.R. reported to be PI in a trial supported by grants (no own salary) from the German Ministry of Education and Research (NAVICARE 01GY1911) outside the submitted work. M.D. reported grants from the Heisenberg Programme of the German Research Foundation, grants for fractal analysis of myocardial perfusion from the German Research Foundation, and a grant from the Berlin University Alliance (GC_SC_PC 27) outside the submitted work. In addition, M.D. holds a joint patent with Florian Michallek on dynamic perfusion analysis using fractal analysis (PCT\/EP2016\/071551 and USPTO 2021 10,991,109 approved), and M.D. is European Society of Radiology (ESR) Research Chair (2019\u20132022) and ESR Publications Chair (2022\u20132025); the opinions expressed in this article are the author\u2019s own and do not represent the view of ESR. Per the guiding principles of ESR, the work as Research and Publications Chair is on a voluntary basis, and only remuneration of travel expenses occurs. M.D. is also the editor of\n                      Cardiac CT\n                      , published by Springer Nature, and offers hands-on courses on CT imaging (\n                      \n                      ). Institutional master research agreements exist with Siemens, General Electric, Philips and Canon. The terms of these arrangements are managed by the legal department of Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Five of the authors have significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all participants in this trial before randomisation.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"This trial was approved by the ethics committee of the Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin (EA1-1-080-08) and by the German Federal Office for Radiation Protection (Z5\u201322462\/2\u20132008-048).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Since it is a prespecified cost-utility analysis, all study subjects have been previously reported in CAD-MAN clinical trial (NCT00844220).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}