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Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

ABSTRACT: OBJECTIVES:The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). SETTING:Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation's public healthcare system. PARTICIPANTS:Hypothetical cohort of patients with pretest probability of CAD between 20% and 70%. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome is cost per correct diagnosis of CAD. Proportion of false-positive or false-negative tests and number of unnecessary tests performed were also evaluated. RESULTS:Strategies using Ex-ECG as initial test were the least costly alternatives but generated more frequent false-positive initial tests and false-negative final diagnosis. Strategies based on CTA or ECHO as initial test were the most attractive and resulted in similar cost-effectiveness ratios (I$ 286 and I$ 305 per correct diagnosis, respectively). A strategy based on C-MRI was highly effective for diagnosing stable CAD, but its high cost resulted in unfavourable incremental cost-effectiveness (ICER) in moderate-risk and high-risk scenarios. Non-invasive strategies based on SPECT have been dominated. CONCLUSIONS:An anatomical diagnostic strategy based on CTA is a cost-effective option for CAD diagnosis. Functional strategies performed equally well when based on ECHO. C-MRI yielded acceptable ICER only at low pretest probability, and SPECT was not cost-effective in our analysis.

SUBMITTER: Bertoldi EG

PROVIDER: S-EPMC5623398 | biostudies-other | 2017 May

REPOSITORIES: biostudies-other

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Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

Bertoldi Eduardo G EG Stella Steffen F SF Rohde Luis Eduardo P LEP Polanczyk Carisi A CA

BMJ open 20170504 4

<h4>Objectives</h4>The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI).<h4>Setting</h4>Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermed ...[more]

PMID: 28473507

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Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

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Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

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