Discovery CT750 HD (GE Healthcare) has been included in the first fully positive recommendation from UK’s National Institute for Health and Clinical Excellence (NICE)’s Diagnostic Assessment Programme which aims to ensure the National Health Service (NHS) can rapidly and consistently adopt clinically and cost effective technologies.
NICE has recommended the Discovery CT750 HD scanner as an option for first line cardiac imaging of the coronary arteries in people with suspected coronary artery disease and for evaluating known coronary artery disease patients’ disease progression to establish the necessity for revascularisation in people deemed difficult to image using earlier generation CT scanners.
NICE’s recent clinical guideline on chest pain (CG95) cites an estimated 2.6 million people in the UK with coronary artery disease. Additionally it is estimated that 1% of the general population consults their General Practitioner (GP) with chest pain.
Historically, factors including patient obesity, high levels of coronary calcium, high heart rates of over 65 beats per minute, the presence of stents or arrhythmias have caused difficulties in imaging patients with earlier generation CT scanners.
However, the latest technology in new generation scanners helps overcome these difficulties, and allows high quality images to be acquired faster and with a reduced radiation dose, which can mean less exposure and less time in a scanner for patients.
The NICE recommendation paves the way for reliably ruling out significant stenosis in ‘difficult to image’ patients, avoiding the need for uncomfortable and more costly investigations such as invasive coronary angiography.
At the end of 2010 the National Audit Office (NAO) recorded 426 NHS CT scanners in England, of which 376 were installed in the last ten years. Of the current scanners in use only 40 are new generation. With NAO estimating that 50% of all NHS CT scanners will need replacing in the next three years, and that number rising to 80% within six years, many local service providers and commissioners will now be considering the prevalence in their local populations of cardiac patients who fall into this ‘difficult to image’ category.
Carole Longson, director for NICE’s Health Technology Evaluation Centre said: “We recommend that when selecting CT scanners as part of their medium term asset planning, service providers, working with commissioners and cardiac networks, take into account the benefits outlined in our guidance of access to new generation cardiac CT scanners.”
To date no assessment in NICE’s Diagnostic Assessment Programme has resulted in a fully positive recommendation, primarily falling short due to the challenges that diagnostics face in demonstrating clinical and cost effectiveness compared with the more direct evidence generated by pharmacological treatments.
Geoff Wilson who leads the European Health Economics team at GE Healthcare said: “We are fully behind evidence based medicine. NICE guidance offers the NHS independently assessed evidence helping commissioners identify more innovative, clinically effective and cost effective medical technologies for their clinicians. The GE Discovery CT750 HD was introduced in 2008 as the world’s first high definition CT system. The improved resolution makes a big difference in ‘difficult to image’ patients. The NICE guidance demonstrates there are financial savings to be made by the NHS using new generation scanners for cardiac imaging in these patients. Moreover following the guidance can lead to improved patient care, often eliminating the need for unnecessary investigations.”
Stephen Harden, Southampton General Hospital, UK, said: “This is an important guidance which will have a positive impact on the practice and growth of cardiac CT. It demonstrates that cardiac CT is an established, clinically useful technique which, according to current evidence, can be used even with difficult to image patients. It is likely that more cardiac CT scans will be performed because of increasing referrer confidence in the technique. It is also likely that this increased demand will encourage more units to consider starting their own cardiac CT programme.”
