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Assessing the downstream value of first-line cardiac positron emission tomography (PET) imaging using real world Medicare fee-for-service claims data

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Higher imaging quality makes cardiac positron emission tomography (PET) desirable for evaluation of suspected coronary artery disease (CAD). High cost of PET imaging may be offset by reduced utilization and/or improved outcomes.

Methods

This retrospective observational study utilized Medicare fee-for-service dataset. Study participants had no CAD diagnosis within 1 year prior to initial imaging. The PET group (PET imaging) and propensity score matched comparison group (single photon emission computed tomography or stress echocardiography) underwent index imaging between January 2014 and December 2016. Outcomes were analyzed using generalized linear models.

Results

Among 144,503 study subjects, 4619 (3.2%) had PET and 139,884 (96.8%) had conventional imaging. After matching, each group had 4619 patients (mean age 74 years, 59% female). The PET group had lower radiation exposure (3.8 milliSievert less per year, 95% CI − 3.96 to − 3.64, P < .0001) and unstable coronary syndrome (incidence rate ratio (IRR) 0.77, 95% CI 0.64-0.94, P = .008). The PET group experienced more hospital admissions (IRR 1.10, 95% CI 1.06-1.15, P < .0001), more use of percutaneous coronary intervention (IRR 1.24, 95% CI 1.02-1.50, P = 0.03), while similar mortality rate (hazard ratio 0.95, 95% CI 0.78-1.14, P = 0.55). The PET group had higher medical spending ($2358.2 vs $1774.3, difference = $583.9 per patient per month, P < .0001).

Conclusions

First-line PET imaging was not associated with reduced levels of utilization and spending. Clinical outcomes were mostly similar.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CMS:

Centers for Medicare and Medicaid Services

CT:

Computerized tomography

FFS:

Fee for service

IRR:

Incidence rate ratio

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

PPPM:

Per patient per month

SPECT:

Single photon emission computerized tomography

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Disclosure

Authors Qinli Ma and Abiy Agiro are employed by HealthCore, Inc, a wholly owned subsidiary of Anthem, Inc. Author Gayathri Sridhar was employed by HealthCore, Inc when the study was conducted. Thomas Powers is employed by AIM Specialty Health, a wholly owned subsidiary of Anthem, Inc. Authors Ma, Agiro, Sridhar, and Powers have no conflicts of interest to disclose.

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Authors and Affiliations

  1. HealthCore Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA

    Qinli Ma PhD, Gayathri Sridhar PhD & Abiy Agiro PhD

  2. AIM Specialty Health, Chicago, IL, USA

    Thomas Power MD, FACC, MRCPI

Authors
  1. Qinli Ma PhD
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  2. Gayathri Sridhar PhD
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  3. Thomas Power MD, FACC, MRCPI
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  4. Abiy Agiro PhD
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Correspondence to Qinli Ma PhD.

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The funding for this project was provided entirely by Anthem, Inc.

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Ma, Q., Sridhar, G., Power, T. et al. Assessing the downstream value of first-line cardiac positron emission tomography (PET) imaging using real world Medicare fee-for-service claims data. J. Nucl. Cardiol. 28, 2126–2137 (2021). https://doi.org/10.1007/s12350-019-01974-8

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  • DOI: https://doi.org/10.1007/s12350-019-01974-8

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