Cost-Effectiveness Analysis of Coronary Computed Tomography Angiography as the Preferred Exam in the Investigation of Stable Chest Pain in the Brazilian Private Healthcare System

Shiozaki, Afonso; Torreão, Jorge; Costa, Isabela Bispo Santos da Silva; Suarez, Anuncia Bouzas; Silva, Marcelo Tozatti da; Oliveira, Thiago Godoy de; Lopes, Luana Emanuelly Sinhori; Nita, Marcelo Eidi; Trad, Henrique; Rochitte, Carlos E.

doi:10.36660/abc.20250204

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Original Article • Arq. Bras. Cardiol. 122 (12) • Dec 2025 • https://doi.org/10.36660/abc.20250204i linkcopy

Cost-Effectiveness Analysis of Coronary Computed Tomography Angiography as the Preferred Exam in the Investigation of Stable Chest Pain in the Brazilian Private Healthcare System

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Cardiovascular disease is the leading cause of mortality worldwide. Strategies that prioritize early diagnosis can reduce the incidence of related complications and cost.

Objective To assess the cost-effectiveness of coronary computed tomography angiography (CCTA) as the initial diagnostic strategy for stable chest pain in patients with intermediate pre-test probability of stable coronary artery disease (CAD), in comparison with invasive coronary angiography (ICA).

Methods A cost-effectiveness analysis was conducted comparing CCTA and ICA, considering data from the Brazilian private healthcare system. The model considered the direct costs of diagnostic exams, medical supplies, hospitalization for myocardial infarction, and myocardial revascularization in the 5 regions of Brazil. A budget impact analysis was performed regarding the gradual incorporation of CCTA over 5 years, considering 100,000 lives as the eligible population.

Results The cost-effectiveness analysis comparing CCTA to ICA, estimated for a population of 100,000 lives, demonstrated cost savings of BRL 1,021.00 per life or a total of BRL 102,069,703.00 by the end of the fifth year. When considering the regional average cost of CCTA, for a population of 100,000 over 5 years, we observed the following cost savings per life and in 5 years, respectively: BRL 1,226.00 and BRL 122,577,793.00 in the North Region; BRL 1,460.00 and BRL 145,988,367.00 in the Northeast Region; BRL 1,625.00 and BRL 162,502,626.00 in the Central-West Region; BRL 1,313.00 and BRL 131,270,230.00 in the Southeast Region; and BRL 1,043.00 and BRL 104,268,937.00 in the South Region.

Conclusion As an initial strategy for investigating stable chest pain, CCTA is cost-effective compared to ICA and is associated with significant cost reductions in the Brazilian private healthcare system.

Keywords:
X-Ray Computed Tomography; Coronary Artery Disease; Cost-Effectiveness Analysis; Myocardial Infarction

Central Illustration:
Cost-Effectiveness Analysis of Coronary Computed Tomography Angiography as the Preferred Exam in the Investigation of Stable Chest Pain in the Brazilian Private Healthcare System

Outcome	Event probability with CCTA (%) N=1808*	Event probability with ICA (%) N=1753*	Total cost (BRL)	Cost difference (BRL)	ICER
Acute myocardial infarction	38 (2.1%)	52 (3.0%)	1,540.67	−686,86	Dominant
Myocardial revascularization	256 (14.2%)	315 (18.0%)	2,142.47	−811,09	Dominant
Hospitalizations	10 (0.2%)	3 (0.6%)	1,359.73	−684,41	Dominant

Region	Cost of CCTA (BRL)	Cost of ICA (BRL)	Cost difference (BRL)	AMI with CCTA (event probability, %)	AMI with ICA (event probability, %)	Probability difference	ICER
Southeast	845.00	2,249.00	–1,404.00	2,100 (2.1%)	3,000 (3.0%)	0.009	Dominant
Northeast	813.00	2,410.00	–1,597.00				Dominant
Central-West	726.00	2,540.00	–1,814.00				Dominant
South	636.00	1,686.00	–1,050.00				Dominant
North	760.00	2,050.00	–1,290.00				Dominant

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[TFN1001] *Original data extracted from the DISCHARGE study.¹⁷ CCTA: coronary computed tomography angiography; ICA: invasive coronary angiography; ICER: incremental cost-effectiveness ratio.