Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience
ABSTRACT: Background: Exercise cardiovascular magnetic resonance (ExCMR) imaging using supine in-scanner ergometer has shown promise in differentiating pathological dilated cardiomyopathy (DCM) from physiological exercise-induced cardiac remodeling. Since 2020, the National Heart Centre Singapore (...
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Elsevier
2025-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664725000869 |
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| author | Sameera Senanayake Sheryl Wei Xuan Lieo Aisyah Binte Latib Sanjeewa Kularatna Nicholas Graves Michelle Swee Leng Kui Declan P. O’Regan Mark Yan Yee Chan Derek John Hausenloy Calvin Woon Loong Chin Thu-Thao Le |
| author_facet | Sameera Senanayake Sheryl Wei Xuan Lieo Aisyah Binte Latib Sanjeewa Kularatna Nicholas Graves Michelle Swee Leng Kui Declan P. O’Regan Mark Yan Yee Chan Derek John Hausenloy Calvin Woon Loong Chin Thu-Thao Le |
| author_sort | Sameera Senanayake |
| collection | DOAJ |
| description | ABSTRACT: Background: Exercise cardiovascular magnetic resonance (ExCMR) imaging using supine in-scanner ergometer has shown promise in differentiating pathological dilated cardiomyopathy (DCM) from physiological exercise-induced cardiac remodeling. Since 2020, the National Heart Centre Singapore (NHCS) has incorporated ExCMR into its clinical workflow for patients with suspected DCM. This study aims to compare the costs associated with ExCMR versus conventional CMR in the evaluation of DCM. Methods: A retrospective analysis was conducted on patients referred for conventional CMR between 2016 and 2019, and those referred for ExCMR from 2020 to 2023. Both imaging modalities followed standardized protocols, with ExCMR incorporating additional assessments during peak exercise. Costs were recorded in Singapore dollars (SGD) prior to the application of healthcare subsidies. Results: The total cost for conventional CMR was SGD 1831.36, while ExCMR was associated with a higher initial cost of SGD 2336.48. However, ExCMR resulted in significantly fewer abnormal imaging findings and a reduced need for follow-up investigations (6.5% (9/139) vs 56.8% (71/125), p<0.001). A decision tree analysis and probabilistic sensitivity analysis (PSA) revealed that diagnosing 1000 suspected DCM patients with ExCMR could result in a cost savings of approximately SGD 182,323 compared to conventional CMR, with a 64% probability of being cost-effective. Conclusion: These findings indicate that ExCMR offers a physiologically informative approach for diagnosing DCM, with the potential to reduce overdiagnosis of cardiac dilatation in active, healthy adults. Although further research is necessary to assess long-term outcomes, ExCMR appears to be a cost-effective imaging modality for DCM diagnosis, warranting reconsideration of its perceived higher cost. |
| format | Article |
| id | doaj-art-54e226e7074f4494a4eae99a809b3efd |
| institution | DOAJ |
| issn | 1097-6647 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-54e226e7074f4494a4eae99a809b3efd2025-08-20T03:17:24ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472025-01-0127210192410.1016/j.jocmr.2025.101924Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experienceSameera Senanayake0Sheryl Wei Xuan Lieo1Aisyah Binte Latib2Sanjeewa Kularatna3Nicholas Graves4Michelle Swee Leng Kui5Declan P. O’Regan6Mark Yan Yee Chan7Derek John Hausenloy8Calvin Woon Loong Chin9Thu-Thao Le10Health Services and Systems Research Program, Duke-NUS Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, SingaporeClinical & Translational Research Office, National Heart Centre Singapore, SingaporeClinical & Translational Research Office, National Heart Centre Singapore, SingaporeHealth Services and Systems Research Program, Duke-NUS Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, SingaporeHealth Services and Systems Research Program, Duke-NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeMedical Research Council Laboratory of Medical Sciences, Imperial College London, London, United KingdomDepartment of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, SingaporeNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore; The Hatter Cardiovascular Institute, University College London, London, United KingdomNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Department of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Program, Duke-NUS Medical School, SingaporeNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Corresponding author.ABSTRACT: Background: Exercise cardiovascular magnetic resonance (ExCMR) imaging using supine in-scanner ergometer has shown promise in differentiating pathological dilated cardiomyopathy (DCM) from physiological exercise-induced cardiac remodeling. Since 2020, the National Heart Centre Singapore (NHCS) has incorporated ExCMR into its clinical workflow for patients with suspected DCM. This study aims to compare the costs associated with ExCMR versus conventional CMR in the evaluation of DCM. Methods: A retrospective analysis was conducted on patients referred for conventional CMR between 2016 and 2019, and those referred for ExCMR from 2020 to 2023. Both imaging modalities followed standardized protocols, with ExCMR incorporating additional assessments during peak exercise. Costs were recorded in Singapore dollars (SGD) prior to the application of healthcare subsidies. Results: The total cost for conventional CMR was SGD 1831.36, while ExCMR was associated with a higher initial cost of SGD 2336.48. However, ExCMR resulted in significantly fewer abnormal imaging findings and a reduced need for follow-up investigations (6.5% (9/139) vs 56.8% (71/125), p<0.001). A decision tree analysis and probabilistic sensitivity analysis (PSA) revealed that diagnosing 1000 suspected DCM patients with ExCMR could result in a cost savings of approximately SGD 182,323 compared to conventional CMR, with a 64% probability of being cost-effective. Conclusion: These findings indicate that ExCMR offers a physiologically informative approach for diagnosing DCM, with the potential to reduce overdiagnosis of cardiac dilatation in active, healthy adults. Although further research is necessary to assess long-term outcomes, ExCMR appears to be a cost-effective imaging modality for DCM diagnosis, warranting reconsideration of its perceived higher cost.http://www.sciencedirect.com/science/article/pii/S1097664725000869Exercise cardiovascular magnetic resonanceDilated cardiomyopathyCost effectiveness |
| spellingShingle | Sameera Senanayake Sheryl Wei Xuan Lieo Aisyah Binte Latib Sanjeewa Kularatna Nicholas Graves Michelle Swee Leng Kui Declan P. O’Regan Mark Yan Yee Chan Derek John Hausenloy Calvin Woon Loong Chin Thu-Thao Le Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience Journal of Cardiovascular Magnetic Resonance Exercise cardiovascular magnetic resonance Dilated cardiomyopathy Cost effectiveness |
| title | Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience |
| title_full | Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience |
| title_fullStr | Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience |
| title_full_unstemmed | Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience |
| title_short | Cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy—a single-center experience |
| title_sort | cost analysis of exercise cardiac magnetic resonance imaging in suspected dilated cardiomyopathy a single center experience |
| topic | Exercise cardiovascular magnetic resonance Dilated cardiomyopathy Cost effectiveness |
| url | http://www.sciencedirect.com/science/article/pii/S1097664725000869 |
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