Non-invasive diagnostic imaging compared with coronary artery angiography in the diagnosis of coronary artery disease

CMS evidence review | evidence_type=MEDCAC Meeting | record_type=medcac_meeting | document_id=34 | meeting_date=2006-05-18

The Medicare Coverage Advisory Committee will review and evaluate the evidence on the use of non-invasive diagnostic imaging technologies such as computed tomography and magnetic resonance in the diagnosis of coronary artery disease, compared with coronary artery angiography.

Actions Taken: April 19, 2006 Posted Federal Register Notice [PDF, 108KB] and Questions to Panel . Comment period extended through May 1, 2006. May 15, 2006 Posted roster , agenda , and Technology Assessment . May 20, 2006 Posted question scoring sheet [PDF, 131KB]. September 01, 2006 Posted transcript [PDF, 579KB]. November 17, 2006 Posted minutes [PDF, 1MB]. Agenda: Federal Register Notice Medicare Coverage Advisory Committee May 18, 2006 7:30 AM - 4:30 PM CMS Multi-Purpose Room Agenda Alan M. Garber, MD, PhD, Chairperson Alex Krist, MD, Vice-Chairperson Steve Phurrough, MD, MPA, Coverage and Analysis Group Michelle Atkinson, Executive Secretary 7:30 - 8:00 AM Registration 8:00 - 8:20 AM Opening Remarks— M. Atkinson / S. Phurrough, MD, MPA/A.Garber, MD, PhD 8:20 8:30 AM CMS Presentation and Presentation of Voting Questions: Stuart Caplan, RN, MAS 8:30 - 8:50 AM CMS Clinical Background: Jim Rollins, MD 8:50 - 9:25 AM Presentation of the TA: Dr. Daniel Mark, Dr. Manesh Patel, Dr. Lynne Hurwitz, Duke University 9:25 - 9:45 AM Presentation: Elliott Fishman, MD, ACR 9:45 - 10:00AM Presentation: John Hodgson, MD, FSCAI, Society for Cardiovascular Angiography and Interventions 10:00 - 10:15AM Presentation: Kim Allan Williams, MD American College of Cardiology 10:15 - 10:30 AM BREAK 10:30 - 11:30 AM Scheduled Public Comments (Refer to Speaker List) Public attendees, who have contacted the executive secretary prior to the meeting, will address the panel and present information relevant to the agenda. Speakers are asked to state whether or not they have any financial involvement with manufacturers of any products being discussed or with their competitors and who funded their travel to this meeting. 11:30 - 12:00 PM Open Public Comments Public Attendees who wish to address the panel will be given that opportunity 12:00 - 1:00PM LUNCH (on your own) 1:00 - 1:30 AM Questions to Presenters 1:30 - 2:30 PM Open Panel Deliberations: Dr. Garber 2:30 - 2:45 PM BREAK 2:45 - 3:15 PM Open Panel Deliberations (continued) 3:15 - 4:15 PM Formal Remarks and Vote The Chairperson will ask each panel member to state his or her position on the voting questions 4:15 - 4:30 PM Closing Remarks / Adjournment: Dr. Phurrough, Dr. Garber 4:30 PM ADJOURN Issue: The Medicare Coverage Advisory Committee will review and evaluate the evidence on the use of non-invasive diagnostic imaging technologies such as computed tomography and magnetic resonance in the diagnosis of coronary artery disease, compared with coronary artery angiography. Minutes: Download Minutes [PDF, 1MB]. Other Material: Transcript 1 Panel Voting Questions: MCAC Questions Non Invasive Imaging for Coronary Artery Disease How confident are you that there is sufficient evidence to determine the diagnostic accuracy of the following noninvasive technologies for the detection of obstructive coronary artery lesions? Computed tomography angiography Electron beam tomography MRI Other identified technologies Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 How confident are you that there is sufficient evidence to determine if these noninvasive technologies can accurately determine the anatomic location of obstructive coronary artery lesions? Computed tomography angiography Electron beam tomography MRI Other identified technologies Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 How confident are you that there is sufficient evidence to determine if these noninvasive technologies can accurately detect the relevant morphology (size, shape, ulceration, etc.) of obstructive coronary artery lesions? Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 Computed tomography angiography Electron beam tomography MRI Other identified technologies How confident are you that non-invasive imaging (identified in Q1-3 as having sufficient evidence) can be used instead of coronary artery catheterization to determine treatment of coronary artery disease? If you are confident or very confident, in which populations are you confident that non-invasive imaging can be used without resulting in adverse health outcomes? Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 If non-invasive imaging (identified in Q1-3 as having sufficient evidence) were to be used in addition to coronary artery catheterization: How confident are you that noninvasive imaging (identified in Q1-3 as having sufficient evidence) provides an incremental benefit or harm when used before coronary artery catheterization? Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 How confident are you that noninvasive imaging (identified in Q1-3 as having sufficient evidence) provides an incremental benefit or harm when used after coronary artery catheterization? Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 How confident are you that: The diagnostic test characteristics of the technologies (identified in Q1-3 as having sufficient evidence) are generalizable to the Medicare beneficiary population Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 Diagnostic and treatment strategies using non-invasive imaging (identified in Q1-3 as having sufficient evidence) of coronary artery disease provide a net health benefit to Medicare beneficiaries compared to strategies that use invasive imaging? Very confident Somewhat confident Unsure Somewhat unconfident Very unconfident 5 4 3 2 1 Net health benefit - Balance between risks and benefits including complications of treatment Download scoresheet [PDF, 130KB] Roster: Medicare Coverage Advisory Committee May 18, 2006 CMS Alan M. Garber, M.D, Ph.D. (CHAIR) Director, Center for Primary Care and Outcomes Research Stanford University Stanford, CA Alexander H. Krist, MD Department of Family Medicine Virginia Commonwealth University Richmond, VA Timothy M. Bateman, MD Cardiovascular Consultants, PC Kansas City, MI Douglas D. Bradham, Dr.P.H.j Director, Health Services Research and Development Center Baltimore, MD David J. Cohen, MD, MSc Cardiovascular Division Beth Israel Deaconess Medical Center Boston, MA Carole Redding Flamm, M.D, M.P.H. BCBSA/TEC Chicago, IL Clifford Goodman, PhD Vice President The Lewin Group Falls Church, VA Rita F. Redberg, MD, MSc University of California, San Francisco Medical Center Division of Cardiology San Francisco, CA Deborah Shatin, PhD Senior Researcher Director Center for Health Care Policy and Evaluation UnitedHealth Group Minneapolis, MN Richard L. Wahl, MD Director, Division of Nuclear Medicine Vice-Chair for Technology and New Business Development Johns Hopkins Medical Institutions Baltimore, MD Consumer Representative Charles J. Queenan, III Independent Management Consultant McLean, VA Industry Representative Lisa Egbuonu-Davis, MD, MPH Pfizer, Inc. New York, NY Guest Panel Experts Elliot Fishman M. D. Johns Hopkins Hospital Dept. of Radiology Baltimore, MD David Lu, MD Cath Lab Director, Washington VAMC Assistant Professor of Medicine, Georgetown University Washington, DC Robert W Peters, MD VA Medical Center Baltimore, MD CMS Liaison Steve Phurrough, MD, MPA Director, Coverage and Analysis Group Executive Secretary Michelle Atkinson