Problem

This topic was selected because of the potential for widespread use of CCTA technology for persons with low to intermediate risk of cardiovascular disease and the lack of evidence of effectiveness of CCTA in preventing adverse cardiac events.  When this project was adopted in 2006 many health plans had policies restricting coverage and payment for CCTA.

Project History

 In 2007, the CMTP Advisory Group developed a protocol for a randomized controlled trial (RCT) comparing clinical outcomes for patients at intermediate risk for CAD initially evaluated with CCTA (64-slice and higher) against outcomes for patients receiving other diagnostic tests. The study endpoints included occurrence of major adverse cardiac events within 24 months, rates of coronary angiography, revascularization, ED visits, hospitalization, number and cost of added imaging tests, and radiation dose.  The decision by the federal Centers for Medicare and Medicaid Services (CMS) in March 2008 not to mandate coverage with evidence development (CED) as a condition for reimbursement rendered the conduct of an RCT unfeasible.  Thus, CCTA is under reconsideration as a CMTP Applied Policy Project. 

CCTA Working Group