Cost-effectiveness Analysis of Anatomic vs Functional Index Testing in Patients With Low-Risk Stable Chest Pain

Key Points Question Are first-line anatomic approaches to low-risk stable chest pain evaluation cost-effective compared with functional testing? Findings In this cost-effectiveness analysis using an individual-based Markov microsimulation model based on 10 003 participants in a randomized clinical trial, anatomic approaches were cost-effective compared with functional testing across a wide range of variations in clinical care and patient characteristics. Adding fractional flow reserve to coronary computed tomography angiography resulted in modest improvements after the initially increased costs of care were offset by fewer and more targeted coronary revascularizations. Meaning These findings suggest that anatomic strategies may present a favorable initial diagnostic option in the evaluation of low-risk stable chest pain compared with functional testing.