Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease

Details

Serval ID
serval:BIB_2D2DC29184A2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease
Journal
European Heart Journal - Quality of Care and Clinical Outcomes
Author(s)
Pletscher Mark, Walker Simon, Moschetti Karine, Pinget Christophe, Wasserfallen Jean-Blaise, Greenwood John P., Schwitter Juerg, Girardin François R.
ISSN
2058-5225
2058-1742
Publication state
Published
Issued date
07/2016
Peer-reviewed
Oui
Volume
2
Number
3
Pages
201-207
Language
english
Abstract
The aim of this study was to assess the cost-effectiveness of eight common diagnostic work-up strategies for coronary
heart disease (CHD) in patients with stable angina symptoms in Switzerland.
Methods and results
A decision analytical model was used to perform a cost-effectiveness comparison of eight common multitest strategies
to diagnose CHD using combinations of four diagnostic techniques: exercise treadmill test (ETT), single-photon emission
computed tomography (SPECT), cardiac magnetic resonance imaging (CMR), and coronary angiography (CA). We used a Markov state transition model to extrapolate the results over a life-time horizon, from a third-party payer perspective.
We used a CHD prevalence rate of 39% in patients and a base-case scenario with 60-year-old male patients with intermediate symptom severity Canadian Cardiovascular Society grading of angina pectoris 2 and at least one cardiovascular
(CV) risk factor but without a history of myocardial infarction and without need for revascularization. Among the eight work-up strategies, one strategy was dominant, i.e. least costly and most effective: ETT followed by CMR if the ETT result was inconclusive and then CA if the CMR result was positive or inconclusive. The CMR features a favourable balance between false-negative diagnoses, associated with an elevated risk of CV events, and false-positive diagnoses, leading to unnecessary CA and related mortality. Key parameters guiding the diagnostic strategy are the prevalence of CHD in patients with angina symptoms and the diagnostic costs of CA and CMR.
Open Access
Yes
Create date
14/12/2017 14:58
Last modification date
20/08/2019 13:12
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