{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:04:31Z","timestamp":1789765471029,"version":"4.0.1"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,9,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Transthyretin cardiac amyloidosis (ATTR\u2010CMP) is an increasingly recognized and treatable cause of heart failure with preserved ejection fraction. Multimodality cardiac imaging is recommended for ATTR\u2010CMP diagnosis, but its cost\u2010effectiveness in current clinical practice has not been well studied.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Using a microsimulation model, we compared the cost\u2010effectiveness of a combination of strategies involving\n              <jats:sup>99m<\/jats:sup>\n              technetium pyrophosphate (PYP), cardiac magnetic resonance imaging, and endomyocardial biopsy for the diagnosis of ATTR\u2010CMP. We developed a decision analytic model to project health care costs and lifetime quality\u2010adjusted 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\u2010CMP. Rates of clinical events, costs, and quality\u2010of\u2010life 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%.\n            <\/jats:p>\n            <jats:p xml:lang=\"en\">In the base\u2010case scenario, using a fixed tafamidis price of $16\u2009000 annually (previously identified cost\u2010effective price), total health care costs per person were lowest for the PYP\u2010only strategy ($209\u2009415) and highest for endomyocardial biopsy strategy ($215\u2009881). Of the 7 strategies examined, the PYP\u2010only strategy had the highest net monetary benefit using a willingness\u2010to\u2010pay threshold of $100\u2009000\/quality\u2010adjusted life year. Results were sensitive to variations in model inputs for PYP and cardiac magnetic resonance imaging specificity, cost of tafamidis, and willingness\u2010to\u2010pay thresholds.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Our model\u2010based analyses showed that a PYP\u2010only strategy to diagnose ATTR\u2010CMP is the most cost\u2010effective strategy, at willingness\u2010to\u2010pay threshold of $100\u2009000\/quality\u2010adjusted life year. At higher threshold ($150\u2009000\/quality\u2010adjusted life year), sequential tests involving PYP and cardiac magnetic resonance imaging may be considered cost effective.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026308","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T09:42:24Z","timestamp":1663148544000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3145-3427","authenticated-orcid":false,"given":"Yin","family":"Ge","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine St. Michael\u2019s Hospital, University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6130-2286","authenticated-orcid":false,"given":"Ankur","family":"Pandya","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-2151","authenticated-orcid":false,"given":"Sarah A. M.","family":"Cuddy","sequence":"additional","affiliation":[{"name":"Amyloidosis Program, Division of Cardiology, Department of Medicine Brigham and Women\u2019s Hospital Boston MA"},{"name":"CV Imaging Program, Cardiovascular Division and Department of Radiology Brigham and Women\u2019s Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1977-1270","authenticated-orcid":false,"given":"Amitoj","family":"Singh","sequence":"additional","affiliation":[{"name":"Sarver Heart Center, Division of Cardiology, Department of Medicine University of Arizona, Tucson (Banner University Medical Center) Tucson AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1717-005X","authenticated-orcid":false,"given":"Avinainder","family":"Singh","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine Brigham and Women\u2019s Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1462-1185","authenticated-orcid":false,"given":"Sharmila","family":"Dorbala","sequence":"additional","affiliation":[{"name":"Amyloidosis Program, Division of Cardiology, Department of Medicine Brigham and Women\u2019s Hospital Boston MA"},{"name":"CV Imaging Program, Cardiovascular Division and Department of Radiology Brigham and Women\u2019s Hospital Boston MA"},{"name":"Division of Nuclear Medicine and Molecular Imaging, Department of Radiology Brigham and Women\u2019s Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021612"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805689"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-020-01252-4"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-016-0915-z"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv338"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa170"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx350"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2020.04.007"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-019-01760-6"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000950"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000792"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa054744"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X98018002S09"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.045093"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540150055031"},{"key":"e_1_3_1_17_2","first-page":"217","volume-title":"Cardiomyopathy: Clinical, Pathological and Theoretical Aspects","author":"Sekiguchi M","year":"1980","unstructured":"Sekiguchi M, Take M. 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