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Erschienen in: Current Cardiovascular Imaging Reports 2/2018

01.02.2018 | Cardiac Nuclear Imaging (A Cuocolo and M Petretta, Section Editors)

Appropriateness and Budget Limitations: Effects on the Use of Cardiac Imaging Techniques

verfasst von: Claudio Marcassa, Orazio Zoccarato

Erschienen in: Current Cardiovascular Imaging Reports | Ausgabe 2/2018

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Abstract

Purpose of the Review

In recent years, increasing economical limitations resulted in a general reduction in health care spending possibilities and, finally, in budget limitations. The potential impact of these economical restrictions on cardiac imaging is discussed.

Recent Findings

Imaging techniques are responsible of a consistent amount of the health care spending, in particular cardiovascular imaging techniques and, among them, radionuclide imaging modalities. To contain costs, the focus of payers, scientific societies, and political organizations is mainly set to reduce the number of exam, mainly by acting on inappropriate testing, that is the overuse. However, the underuse, which consists in studies that actually are indicated, according to guidelines, but are not performed, is also responsible of a possible rise in long-term costs for the health care system through missing early diagnosis and thus not preventing possible events in high risk subjects.

Summary

Because of budget constraint, actions to reduce the number of cardiac imaging studies by improving the appropriateness of the indications and to contain investments in hardware and software upgrading are promoted. A different approach is discussed.
Literatur
1.
Zurück zum Zitat • Dieleman JL, Templin T, Sadat N, et al. National spending on health by source for 184 countries between 2013 and 2040. Lancet. 2016;387(10037):2521–35. The most recent document analyzing the trend in worldwide healthcare spending.CrossRefPubMed • Dieleman JL, Templin T, Sadat N, et al. National spending on health by source for 184 countries between 2013 and 2040. Lancet. 2016;387(10037):2521–35. The most recent document analyzing the trend in worldwide healthcare spending.CrossRefPubMed
10.
Zurück zum Zitat Appropriateness in health care services. A report on a WHO workshop. World Health Organization Health Series 21, Geneva, World Health Organization, 2000. Appropriateness in health care services. A report on a WHO workshop. World Health Organization Health Series 21, Geneva, World Health Organization, 2000.
12.
Zurück zum Zitat Hendel RC, Cerqueira M, Douglas PS, et al. A multicenter assessment of the use of single-photon emission computed tomography myocardial perfusion imaging with appropriateness criteria. J Am Coll Cardiol. 2010;55:156–62.CrossRefPubMed Hendel RC, Cerqueira M, Douglas PS, et al. A multicenter assessment of the use of single-photon emission computed tomography myocardial perfusion imaging with appropriateness criteria. J Am Coll Cardiol. 2010;55:156–62.CrossRefPubMed
14.
Zurück zum Zitat Gholamrezanezhad A, Shirafkan A, Mirpour S, et al. Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: a comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria. J Nucl Cardiol. 2011;18:1044–52.CrossRefPubMed Gholamrezanezhad A, Shirafkan A, Mirpour S, et al. Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: a comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria. J Nucl Cardiol. 2011;18:1044–52.CrossRefPubMed
15.
Zurück zum Zitat Moralidis E, Papadimitriou N, Stathaki M, et al. A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece. J Nucl Cardiol. 2013;20:275–83.CrossRefPubMed Moralidis E, Papadimitriou N, Stathaki M, et al. A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece. J Nucl Cardiol. 2013;20:275–83.CrossRefPubMed
16.
Zurück zum Zitat • Medolago G, Marcassa C, Alkraisheh A, Campini R, Ghilardi A, Giubbini R. Applicability of the appropriateness use criteria for SPECT myocardial perfusion imaging in Italy. Preliminary results. Eur J Nucl Med Mol Imaging. 2014;41:1695–700. This manuscript reports on the rate of appropriate, non-appropriate, and uncertain indications in SPECT MPI studies performed in 3 large nuclear cardiology laboratories in Italy.CrossRefPubMed • Medolago G, Marcassa C, Alkraisheh A, Campini R, Ghilardi A, Giubbini R. Applicability of the appropriateness use criteria for SPECT myocardial perfusion imaging in Italy. Preliminary results. Eur J Nucl Med Mol Imaging. 2014;41:1695–700. This manuscript reports on the rate of appropriate, non-appropriate, and uncertain indications in SPECT MPI studies performed in 3 large nuclear cardiology laboratories in Italy.CrossRefPubMed
18.
Zurück zum Zitat Druz RS, Phillips LM, Sharifova G. Clinical evaluation of the appropriateness use criteria for single-photon emission-computed tomography: differences by patient population, physician specialty, and patient outcomes. Int Sch Res Netw ISRN Cardiol. 2011;2011:1–8. https://doi.org/10.5402/2011/798318.CrossRef Druz RS, Phillips LM, Sharifova G. Clinical evaluation of the appropriateness use criteria for single-photon emission-computed tomography: differences by patient population, physician specialty, and patient outcomes. Int Sch Res Netw ISRN Cardiol. 2011;2011:1–8. https://​doi.​org/​10.​5402/​2011/​798318.CrossRef
20.
Zurück zum Zitat •• Roifman I, Austin PC, Qiu F, Wijeysundera HC. Impact of the publication of appropriate use criteria on utilization rates of myocardial perfusion imaging studies in Ontario, Canada: a population-based study. J Am Heart Assoc. 2017;6:e005961. https://doi.org/10.1161/JAHA.117.005961. This very recent manuscript describes the impact of the introduction of the Appropriate Use Criteria on the rate of studies performed and the estimated saving in healthcare spending.CrossRefPubMedPubMedCentral •• Roifman I, Austin PC, Qiu F, Wijeysundera HC. Impact of the publication of appropriate use criteria on utilization rates of myocardial perfusion imaging studies in Ontario, Canada: a population-based study. J Am Heart Assoc. 2017;6:e005961. https://​doi.​org/​10.​1161/​JAHA.​117.​005961. This very recent manuscript describes the impact of the introduction of the Appropriate Use Criteria on the rate of studies performed and the estimated saving in healthcare spending.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Bagrova A, Alsamarah AY, Winchester DE. Comparing two methods for determining appropriateness of myocardial perfusion imaging: criteria from the American College of Cardiology Foundation and the American College of Radiology. J Nucl Cardiol. 2017; https://doi.org/10.1007/s12350-017-0965-1. Bagrova A, Alsamarah AY, Winchester DE. Comparing two methods for determining appropriateness of myocardial perfusion imaging: criteria from the American College of Cardiology Foundation and the American College of Radiology. J Nucl Cardiol. 2017; https://​doi.​org/​10.​1007/​s12350-017-0965-1.
24.
Zurück zum Zitat Shaw LJ, Hachamovitch R, Berman DS, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 1999;33:661–9.CrossRefPubMed Shaw LJ, Hachamovitch R, Berman DS, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 1999;33:661–9.CrossRefPubMed
27.
Zurück zum Zitat Doukky R, Hayes K, Frogge N, et al. Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging. Circulation. 2013;128(15):1634–43.CrossRefPubMed Doukky R, Hayes K, Frogge N, et al. Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging. Circulation. 2013;128(15):1634–43.CrossRefPubMed
29.
Zurück zum Zitat •• Dos Santos MA, Santos MS, Tura BR, Félix R, Brito AS, De Lorenzo A. Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: the perspective of a developing country. J Nucl Cardiol. 2016;23(5):1160–5. This is one of the few manuscripts using the budget impact analysis in medicine, in particular to assess the effect of AUC on the use of MPI, in a developing country.CrossRefPubMed •• Dos Santos MA, Santos MS, Tura BR, Félix R, Brito AS, De Lorenzo A. Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: the perspective of a developing country. J Nucl Cardiol. 2016;23(5):1160–5. This is one of the few manuscripts using the budget impact analysis in medicine, in particular to assess the effect of AUC on the use of MPI, in a developing country.CrossRefPubMed
31.
Zurück zum Zitat Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071–7.CrossRefPubMed Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071–7.CrossRefPubMed
32.
Zurück zum Zitat Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies. In: Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, DC: National Academies Press; 2006. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies. In: Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, DC: National Academies Press; 2006.
33.
Zurück zum Zitat Gerber TC, Carr JJ, Arai AE, et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation. 2009;119(7):1056–65. https://doi.org/10.1161/CIRCULATIONAHA.108.191650.CrossRefPubMed Gerber TC, Carr JJ, Arai AE, et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation. 2009;119(7):1056–65. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​108.​191650.CrossRefPubMed
36.
Zurück zum Zitat •• Hill KD, Einstein AJ. New approaches to reduce radiation exposure. Trends Cardiovasc Med. 2016;26(1):55–65. This review describes a modern approach to reduce the possible long term harmful effect of ionizing radiation on patients and operators, addressing hardware and software solutions.CrossRefPubMed •• Hill KD, Einstein AJ. New approaches to reduce radiation exposure. Trends Cardiovasc Med. 2016;26(1):55–65. This review describes a modern approach to reduce the possible long term harmful effect of ionizing radiation on patients and operators, addressing hardware and software solutions.CrossRefPubMed
37.
Zurück zum Zitat DePuey EG, Gadiraju R, Clark J, et al. Ordered subset expectation maximization and wide beam reconstruction “half-time” gated myocardial perfusion SPECT functional imaging: a comparison to “full-time” filtered backprojection. J Nucl Cardiol. 2008;15:547–63.CrossRefPubMed DePuey EG, Gadiraju R, Clark J, et al. Ordered subset expectation maximization and wide beam reconstruction “half-time” gated myocardial perfusion SPECT functional imaging: a comparison to “full-time” filtered backprojection. J Nucl Cardiol. 2008;15:547–63.CrossRefPubMed
38.
Zurück zum Zitat Marcassa C, Campini R, Zoccarato O, et al. Wide beam reconstruction for half-dose or half-time cardiac gated-SPECT acquisitions: optimization of resources and reduction in radiation exposure. Eur J Nucl Med. 2010;38:499–508.CrossRef Marcassa C, Campini R, Zoccarato O, et al. Wide beam reconstruction for half-dose or half-time cardiac gated-SPECT acquisitions: optimization of resources and reduction in radiation exposure. Eur J Nucl Med. 2010;38:499–508.CrossRef
39.
Zurück zum Zitat • Zoccarato O, Lizio D, Savi A, Indovina L, Scabbio C, Leva L, et al. Comparative analysis of cadmium zincum telluride cameras dedicated to myocardial perfusion SPET. A phantom study. J Nucl Cardiol. 2016;23(4):885–93. An experimental study comparing the characteristics of the two solid-state detectors SPECT dedicated to cardiology.CrossRefPubMed • Zoccarato O, Lizio D, Savi A, Indovina L, Scabbio C, Leva L, et al. Comparative analysis of cadmium zincum telluride cameras dedicated to myocardial perfusion SPET. A phantom study. J Nucl Cardiol. 2016;23(4):885–93. An experimental study comparing the characteristics of the two solid-state detectors SPECT dedicated to cardiology.CrossRefPubMed
40.
Zurück zum Zitat Reyes E, Uderwood SR. Myocardial perfusion imaging in Europe 2007: a survey of the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging. 2012;39:1923–9.CrossRef Reyes E, Uderwood SR. Myocardial perfusion imaging in Europe 2007: a survey of the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging. 2012;39:1923–9.CrossRef
Metadaten
Titel
Appropriateness and Budget Limitations: Effects on the Use of Cardiac Imaging Techniques
verfasst von
Claudio Marcassa
Orazio Zoccarato
Publikationsdatum
01.02.2018
Verlag
Springer US
Erschienen in
Current Cardiovascular Imaging Reports / Ausgabe 2/2018
Print ISSN: 1941-9066
Elektronische ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-018-9445-5

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