Document Detail


Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain.
MedLine Citation:
PMID:  17003046     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. METHODS AND RESULTS: We examined prognosis and cost-effectiveness of exercise echocardiography (n = 4884) vs. SPECT (n = 4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio < Dollars 50,000 per life year saved (LYS) was considered favourable for economic efficiency. The risk-adjusted 3-year death or MI rates classified by extent of ischaemia were similar, ranging from 2.3 to 8.0% for echocardiography and from 3.5 to 11.0% for SPECT (model chi2 = 216; P < 0.0001; interaction P = 0.24). Cost-effectiveness ratios for echocardiography were < Dollars 20,000/LYS when the annual risk of death or MI was < 2%. However, when yearly cardiac event rate were > 2%, cost-effectiveness ratios for echocardiography vs. SPECT were in the range of Dollars 66,686-Dollars 419,522/LYS. For patients with established coronary disease (i.e. > or = 2% annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of Dollars 32,381/LYS. CONCLUSION: Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.
Authors:
Leslee J Shaw; Thomas H Marwick; Daniel S Berman; Stephen Sawada; Gary V Heller; Charles Vasey; D Douglas Miller
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2006-09-26
Journal Detail:
Title:  European heart journal     Volume:  27     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-04     Completed Date:  2007-03-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2448-58     Citation Subset:  IM    
Affiliation:
Cedars-Sinai Medical Center, David Geffen UCLA School of Medicine, Taper Building, Los Angeles, CA 90048, USA. leslee.shaw@cshs.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Angina Pectoris / economics,  radionuclide imaging,  ultrasonography
Cost-Benefit Analysis
Death, Sudden, Cardiac / prevention & control*
Disease-Free Survival
Echocardiography, Stress / economics*
Female
Humans
Male
Myocardial Infarction / economics,  radionuclide imaging,  ultrasonography
Myocardial Ischemia / economics*,  radionuclide imaging,  ultrasonography
Prognosis
Risk Factors
Survival Analysis
Tomography, Emission-Computed, Single-Photon / economics*
Comments/Corrections
Comment In:
Eur Heart J. 2006 Oct;27(20):2378-9   [PMID:  17003047 ]

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