Visualising Coronary Arteries

Coronary artery disease (CAD) is a leading cause of premature death and disability.

In 2011, a health technology assessment (HTA) using novel meta-analyses and economic modelling generated by AHTA² resulted in the creation of Medicare item numbers 57360 and 57361. Multi-slice computed tomography coronary angiography (MSCTCA) is a non-invasive procedure used for viewing blockages in coronary arteries and can be used to rule out significant CAD in symptomatic patients. Use of MSCTCA avoids the known risks associated with the more invasive alternative diagnostic procedure, coronary angiography.

AHTA’s research and subsequent peer reviewed paper³ informed public funding decisions internationally, including in HTA reports informing policy makers in Ontario and Sweden, and in coronary artery imaging guidelines from the Cardiac Society of Australia and New Zealand. AHTA’s modelled analysis has since been supported by a 2016 Scottish randomised controlled trial, which showed that symptomatic patients were more accurately diagnosed using MSCTCA, thereby reducing unnecessary investigations and improving subsequent treatment.

With more than 200,000 tests conducted since 2011 (Medicare data), inclusion of this test greatly improved accuracy and safety of detection of CAD in Australia. AHTA’s research enabled early adoption of this procedure when compared with other countries. For example, in the UK, MSCTCA was only funded as a frontline test for CAD in 2016.

2. Ivan M, Kreisz F, Merlin T, Buckley L, Newton S, et al. (2007) Multi-slice computed tomography coronary angiography in the visualisation of coronary arteries. MSAC application 1105 Assessment Report. Canberra: Commonwealth of Australia. ISBN (print) 1-74186-594-8; ISBN (online) 1-74186-595-6; ISSN (print) 1443-7120; ISSN (online) 1443-7139.

3. Kreisz F, Merlin T, Moss J, Atherton J, Hiller J et. al. (2009). The pre-test risk stratified cost-effectiveness of 64-slice computed tomography coronary angiography in the detection of significant obstructive coronary artery disease in patients otherwise referred to invasive coronary angiography. Heart, Lung & Circulation (print) 18,3:200-7.