Document Detail

Impact of advanced exercise ECG analysis on cost of coronary artery disease management.
MedLine Citation:
PMID:  20545809     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Conventional analysis of exercise electrocardiogram (EX-ECG) has limited accuracy. This study aims to evaluate the potential impact of improving EX-ECG accuracy on costs of diagnosis and number of misdiagnoses of coronary artery disease (CAD).
METHODS: A decision-tree model was simulated including sequential application of diagnostic procedures for suspected CAD. The model was structured in two main branches (presence or absence of CAD). A probabilistic sensitivity analysis was then performed for several combinations of improvement in test sensitivity and specificity.
RESULTS: A clear trend in cost reduction was observed at improving EX-ECG specificity (about 8-8.5 million dollars, corresponding to a 5.6-7.6% reduction according to the prevalence level). Wrong diagnoses counted for 9-13% of test. Improvements in test parameters lead to reductions in wrong diagnoses, especially when increasing specificity (8.8-12.5%).
CONCLUSIONS: A proper improvement in EX-ECG sensitivity and specificity would have a relevant impact on the costs of CAD management, while reducing the number of misdiagnoses.
Riccardo Bigi; Alberto Ferrando; Eva Pagano; Lauro Cortigiani; Franco Merletti; Cesare Fiorentini; Dario Gregori
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-10
Journal Detail:
Title:  Journal of evaluation in clinical practice     Volume:  16     ISSN:  1365-2753     ISO Abbreviation:  J Eval Clin Pract     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-27     Completed Date:  2010-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9609066     Medline TA:  J Eval Clin Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  678-84     Citation Subset:  IM    
Cardiology, Department of Medicine and Surgery, University School of Medicine, Milan, Italy.
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MeSH Terms
Coronary Artery Disease / diagnosis,  economics*
Costs and Cost Analysis
Decision Trees
Disease Management
Electrocardiography / methods*
Exercise Test*
Models, Theoretical
Monte Carlo Method

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

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