Elsevier

Clinical Imaging

Volume 43, May–June 2017, Pages 97-105
Clinical Imaging

Original Article
Cost-effectiveness of diagnostic evaluation strategies for individuals with stable chest pain syndrome and suspected coronary artery disease

https://doi.org/10.1016/j.clinimag.2017.01.015Get rights and content
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open access

Highlights

  • At 20% risk of obstructive CAD, ETT-CCTA-ICA displayed a favorable ICER of $49,021.

  • At 50% risk of obstructive CAD, ETT-CCTA-ICA strategy cost $63,294 per QALY gained.

  • At 80% risk of obstructive CAD, ETT-ECHO-ICA strategy cost $38,234 per QALY gained.

  • Various diagnostic imaging modalities augment lifetime cost-effectiveness.

Abstract

Purpose

To determine lifetime cost-effectiveness of diagnostic evaluation strategies for individuals with stable chest pain and suspected coronary artery disease (CAD).

Methods

Exercise treadmill testing (ETT), stress echocardiography (SE), myocardial perfusion scintigraphy (MPS), coronary computed tomographic angiography (CCTA), and invasive coronary angiography (ICA) were assessed alone, or in succession to each other.

Results

Initial ETT followed by imaging wherein ETT was equivocal or unable to be performed appeared more cost-effective than any strategy employing initial testing by imaging.

Conclusion

As pre-test likelihood of CAD varies, different modalities including SE, CCTA, and MPS result in improved costs and enhanced effectiveness.

Abbreviations

CAD
coronary artery disease
CCTA
coronary computed tomographic angiography
ECHO
echocardiogram
ETT
exercise treadmill testing
ICA
invasive coronary angiography
ICER
incremental cost-effectiveness ratio
MPS
myocardial perfusion scintigraphy
SE
stress echocardiography
QALY
quality adjusted life year

Keywords

Cost effectiveness
Computed tomography
Stress testing
Echocardiography
Myocardial perfusion SPECT
Invasive angiography

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