Document Detail


Economic analysis of the use of coronary calcium scoring as an alternative to stress ECG in the non-invasive diagnosis of coronary artery disease.
MedLine Citation:
PMID:  21993982     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To conduct an economic analysis (EA) of coronary calcium scoring (CCS) using a 0 score, as alternative to stress electrocardiography (sECG) in diagnosing coronary artery disease (CAD).
METHOD: A decision tree was constructed to compare four strategies for investigation of suspected CAD previously assessed in the formulation of clinical guidelines for the United Kingdom (UK) to two new strategies incorporating CCS. Sensitivity (96%; 95% CI 95.4-96.4%) and specificity (40%; 95% CI 38.7-41.4%) values for CCS were derived from a meta-analysis of 10,760 patients. Other input variables were obtained from a previous EA and average prices for hospital procedures in the UK. A threshold of £30,000/Quality-adjusted Life Year (QALY) was considered cost-effective.
RESULTS: Using net monetary benefit calculations, CCS-based strategies were found to be cost-effective compared to sECG equivalents at all assessed prevalence of CAD. Using CCS prior to myocardial perfusion scintigraphy (MPS) and catheter angiography (CA) was found to be cost-effective at pre-test probabilities (PTP) below 30%.
CONCLUSIONS: Adoption of CCS as an alternative to sECG in investigating suspected stable angina in low PTP population (<30%) would be cost-effective. In patients with PTP of CAD >30%, proceeding to MPS or CA would be more cost-effective than performing either CCS or sECG.
KEY POINTS: Coronary calcium scoring (CCS) is useful for assessing coronary artery atherosclerosis It can be performed with multi-detector CT, which is now widely available It plays a role in excluding disease in suspected stable angina Our study assesses its role in this setting as alternative to stress-ECG Adoption of CCS as an alternative to sECG could prove cost-effective.
Authors:
Vivek Raman; Eric T M McWilliams; Stephen R M Holmberg; Ken Miles
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-10-13
Journal Detail:
Title:  European radiology     Volume:  22     ISSN:  1432-1084     ISO Abbreviation:  Eur Radiol     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-01     Completed Date:  2012-05-31     Revised Date:  2012-11-09    
Medline Journal Info:
Nlm Unique ID:  9114774     Medline TA:  Eur Radiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  579-87     Citation Subset:  IM    
Affiliation:
Brighton and Sussex University Hospitals, Brighton, UK. ramanvivek@doctors.org.uk
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MeSH Terms
Descriptor/Qualifier:
Calcinosis / radiography*
Coronary Angiography / economics*
Coronary Disease / radiography*
Cost-Benefit Analysis
Decision Trees
Electrocardiography / economics
Exercise Test / economics
Great Britain
Humans
Predictive Value of Tests
Quality-Adjusted Life Years
Sensitivity and Specificity
Tomography, X-Ray Computed / economics*

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


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