CT Screening for Coronary Disease Does not Raise Health Care Costs By Kevin Self Reviewed by Elizabeth Klodas, MD, FACC  and   A new study reveals that coronary calcium screening is effective at identifying high risk patients, and can do so without increasing the total cost of healthcare.

Healthcare is a popular topic of discussion today in the United States. The debate has made many patients think about tests, prescription drugs and other factors that collectively determine the cost of healthcare in this country.

It’s no surprise that identifying value in healthcare - looking beyond the price of a test and focusing on its benefits and impact on overall healthcare expenditures - is needed more than ever. This is especially true for cardiac testing, as the economic burden of cardiovascular disease and cardiac care is especially high - estimated at more than $475 billion per year.

A recent study published in the Journal of the American College of Cardiology examines the global costs of screening for coronary artery calcification (CAC).  CAC is assed using a CT scanner.  This is a non-invasive test which is very safe, quick, and associated with very low radiation exposures.  It does not require any special preparation or IV’s, and has been widely available for over 10 years.  The amount of coronary artery calcification (CAC “score”) can be used as a marker of the extent of underlying plaque.   CAC has proven to be effective in identifying patients who are at high risk of developing symptomatic heart disease. However, some argue that CAC screenings are so effective in detecting even small amounts of plaque that this leads to more/unnecessary tests and greater costs in the long-run.

The present study found that few patients with low CAC scores (less than 100) underwent subsequent testing, and the costs were relatively low (less than $35 per patient per year). Patients that incurred more costs over the course of treatment — “downstream” costs — were predominantly those with high-risk CAC scores (401 or more).  These patients were much more likely to undergo subsequent stress testing and coronary angiography. 

In an accompanying editorial, Dr. Roger S. Blumenthal from the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, says that CAC screening is one of the best available tests for dividing patients into two clear groups — those at high and low risk of heart disease — and that the present study goes a long way to alleviate fears that CAC screening leads to higher downstream costs.

So what does this mean for you?

Just because a test does not increase downstream costs of care, does not mean that everyone should have it.  Dr. Blumenthal offers some additional guidance and suggestions for patients considering CAC screening:

1. CAC screening is reasonable if you are a man at least 45 years old, a woman at least 50 years old, have a family history of heart disease, and the decision to treat you with life-long aspirin and cholesterol lowering therapy has not yet been made.
   
2. There is no need for a CAC scan if your doctor has already recommended that you take an aspirin and a cholesterol lowering medication.
   
3. If your coronary artery plaque buildup is higher than the average for someone your age, you do not necessarily need a treadmill stress test, but you need to work with your doctor to improve your lifestyle habits and you’ll most likely be treated with aspirin and a cholesterol lowering medication.

“In general, a CAC scan may be helpful in selected patients to determine if they really need to be on aspirin and medication for the rest of their life to lower their risk of a heart attack or stroke,” says Blumenthal. “The question that patients need to ask their doctor is, ‘Will getting a coronary calcium scan change my management in any way?’ If not, there is no reason to get the test.”

The survey results are published in the September 29, 2009 issue of the Journal of the American College of Cardiology.

Sources: 

Shaw LJ et al. Induced Cardiovascular Procedural Costs and Resources Consumption Patterns After Coronary Artery Calcium Screening. Journal of the American College of Cardiology, 2009

Blumenthal RS et al. Selective Use of Coronary Artery Calcium Screening: Worth the Cost? Journal of the American College of Cardiology, 2009

Roger S. Blumenthal, MD, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD