TY - JOUR
T1 - Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal
AU - Ferreira, Antonio Miguel
AU - Marques, Hugo
AU - Gonçalves, Pedro de Araújo
AU - Cardim, Nuno
PY - 2014/4
Y1 - 2014/4
N2 - Background: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. Objective: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. Methods: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10\% to 90\%. Results: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of <= 50\%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of >= 60\%, up-front invasive coronary angiography appears to be the most cost-effective strategy. Conclusions: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of <= 50\%. In high-risk patients (pretest likelihood of disease >= 60\%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.
AB - Background: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. Objective: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. Methods: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10\% to 90\%. Results: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of <= 50\%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of >= 60\%, up-front invasive coronary angiography appears to be the most cost-effective strategy. Conclusions: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of <= 50\%. In high-risk patients (pretest likelihood of disease >= 60\%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.
KW - ASSOCIATION TASK-FORCE
KW - PRACTICE GUIDELINES
KW - MYOCARDIAL-PERFUSION SPECT
KW - FRACTIONAL FLOW RESERVE
KW - EMISSION COMPUTED-TOMOGRAPHY
KW - Coronary disease / economics
KW - Cost-Benefit analysis
KW - Coronary disease / diagnosis
KW - AMERICAN-COLLEGE
KW - CT ANGIOGRAPHY
KW - INTERMEDIATE
KW - CHEST-PAIN
KW - STRESS ECHOCARDIOGRAPHY
U2 - 10.5935/abc.20140042
DO - 10.5935/abc.20140042
M3 - Article
C2 - 24844876
SN - 0066-782X
VL - 102
SP - 391
EP - 401
JO - Arquivos Brasileiros De Cardiologia
JF - Arquivos Brasileiros De Cardiologia
IS - 4
ER -