Document Detail


Cost-effectiveness analysis of 64-slice computed tomography vs. cardiac catheterization to rule out coronary artery disease before non-coronary cardiovascular surgery.
MedLine Citation:
PMID:  22761509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To explore the cost-effectiveness of two alternative strategies to rule out significant coronary artery disease (CAD) in the pre-operative evaluation of non-coronary cardiovascular surgery: initial pre-operative coronary 64-slice computed tomography angiography (CCTA) vs. invasive coronary angiography (ICA).
METHODS AND RESULTS: These diagnostic strategies are compared from the clinical and payee's perspective, on the basis of the results of four European studies including 490 patients, by an analytic model of a decision tree in terms of the cost-effectiveness as the percentage of catheterizations, complications, and deaths avoided. These studies show that 71.2% of the ICA and 3.56% of the post-ICA complications could have been avoided by an initial pre-operative CCTA with a saving of €411/patient. The sensitivity analysis did not find relevant differences in terms of the cost-effectiveness when we established the indication of ICA vs. CCTA in relation to the amount of coronary calcium and when ICA was always performed by radial access. However, the lack of team experience in CCTA increased the economical and biological cost due to involving an ICA and the exposure to double ionizing radiation sources.
CONCLUSION: In experienced groups, the diagnostic strategy with initial pre-operative CCTA is better than the strategy with initial ICA because it is capable of ruling out significant CAD avoiding ICA and post-ICA morbidity-mortality, with an important saving in the cost of the diagnostic process.
Authors:
Paz Catalán; Daniel Callejo; Juan Antonio Blasco
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-07-02
Journal Detail:
Title:  European heart journal cardiovascular Imaging     Volume:  14     ISSN:  2047-2412     ISO Abbreviation:  Eur Heart J Cardiovasc Imaging     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-11     Completed Date:  2013-08-01     Revised Date:  2013-10-28    
Medline Journal Info:
Nlm Unique ID:  101573788     Medline TA:  Eur Heart J Cardiovasc Imaging     Country:  England    
Other Details:
Languages:  eng     Pagination:  149-57     Citation Subset:  IM    
Affiliation:
Cardiology Department, Ramón y Cajal University Hospital (Madrid), Ctra. Colmenar Km 9,100, 28034 Madrid, Spain. mcatalan.hrc@salud.madrid.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiac Catheterization / economics*,  methods
Cohort Studies
Coronary Angiography / economics*,  methods
Coronary Artery Disease / diagnosis,  radiography*
Cost-Benefit Analysis
Decision Support Techniques
Europe
Female
Heart Diseases / surgery*
Humans
Male
Middle Aged
Multidetector Computed Tomography / economics*,  methods
Preoperative Care / methods
Comments/Corrections
Comment In:
Radiologe. 2013 Sep;53(9):752-4   [PMID:  23975148 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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