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MEDCAC Meeting

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

05/18/2006

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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.

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

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

Minutes

Download Minutes [PDF, 1MB].

Panel Voting Questions

MCAC Questions
Non Invasive Imaging for Coronary Artery Disease
  1. 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?
    1. Computed tomography angiography
    2. Electron beam tomography
    3. MRI
    4. Other identified technologies
Very confident      Somewhat confident      Unsure      Somewhat unconfident      Very unconfident
     5                                  4                                  3                                  2                                  1           
  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?
    1. Computed tomography angiography
    2. Electron beam tomography
    3. MRI
    4. Other identified technologies
Very confident      Somewhat confident      Unsure      Somewhat unconfident      Very unconfident
     5                                  4                                  3                                  2                                  1           
  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           
    1. Computed tomography angiography
    2. Electron beam tomography
    3. MRI
    4. Other identified technologies
  1. 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           

  1. If non-invasive imaging (identified in Q1-3 as having sufficient evidence) were to be used in addition to coronary artery catheterization:

    1. 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           

    2. 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           

  1. How confident are you that:

    1. 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           

    2. 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]

Contact Information

Other Material

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

Associated NCA

Associated Technology Assessment

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