Over the last decade, researchers, manufacturers and clinicians have invested significant effort in perfecting the use of cardiac computed tomography angiography (CCTA) as a non-invasive alternative to angiography, which is currently accepted as the “gold standard” technology to diagnose coronary artery disease (CAD). Although use of the technology has become widespread, the evidence base to guide that use remains incomplete and clinical recommendations contradict one another. This lack of evidence reflects both methodological complexities in studying the effectiveness of diagnostic technologies like CCTA as well as the early decision by many insurers to cover the procedure. Reimbursement for CCTA was so complete by 2008 that the Centers for Medicare and Medicaid Services (CMS) abandoned a proposed national policy that would have covered procedure only as part of clinical research intended to fill the substantial gaps in evidence.
In the fall of 2008, the Center for Medical Technology Policy (CMTP) convened a “think tank” of 43 experts and stakeholders to discuss lessons to be learned from the cardiac computed tomography angiography (CCTA) experience. The backdrop for this meeting was the imminent emergence of yet newer cardiac imaging technologies and a major new national initiative to compare the effectiveness of alternative technologies intended for the same purpose.
The meeting identified several unresolved issues, including”
- Moving beyond measures of diagnostic accuracy to measure health and quality of life outcomes.
- Specification of the technology.
- Measuring comparative value in addition to comparative effectiveness.
- Timing and role of RCTs.
- Role of alternative study designs.
- Role and feasibility of CED.
- Resources and infrastructure.
For more information, please review the CCTA Meeting Summary (pdf) (185.11 kB)