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Cost-effectiveness of myocardial perfusion SPECT and stress test according to coronary revascularization therapy, cardiac events and total mortality: Register of 8,496 patients. Rev Esp Med Nucl Imagen Mol 2020; 39:212-219. [PMID: 32273238 DOI: 10.1016/j.remn.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim was to analyze the cost-effectiveness ratio (CER) of stress electrocardiogram (ES) and stress myocardial perfusion imaging (SPECT-MPI) according to coronary revascularization (CR) therapy, cardiac events (CE) and total mortality (TM). MATERIAL AND METHODS A total of 8,496 consecutive patients who underwent SPECT-MPI were followed-up (mean 5.3±3.5years). Cost-effectiveness for coronary bypass (CABG) or percutaneous CR (PCR) (45.6%/54.4%) according to combined electrocardiographic ischemia and scintigraphic ischemia were evaluated. Effectiveness was evaluated as TM, CE, life-year saved observed (LYSO) and CE-LYSO; costs analyses were conducted from the perspective of the health care payer. A sensitivity analysis was performed considering current CABG/PCR ratios (12%/88%). RESULTS When electrocardiogram and SPECT approaches are combined, the cost-effectiveness values for CABG ranged between 112,589€ (electrocardiographic and scintigraphic ischemia) and 2,814,715€ (without ischemia)/event avoided, 38,664 and 2,221,559€/LYSO; for PCR ranged between 18,824€ (electrocardiographic and scintigraphic ischemia) and 46,377€ (without ischemia)/event avoided, 6,464 and 36,604€/LYSO. To CE: the cost-effectiveness values of the CABG and CPR in presence of electrocardiographic and scintigraphic ischemia were 269,904€/CE-avoided and 24,428€/CE-avoided, respectively; and the €/LYSO of the CABG and PCR were 152,488 and 13,801, respectively. The RCE was maintained for the current proportion of revascularized patients (12%/88%). CONCLUSIONS Combined ES and SPECT-MPI results, allows differentiation between patient groups, where the PCR and CABG are more cost-effective in different economic frameworks. The major CER in relation to CR, CE and TM occurs in patients with electrocardiographic and scintigraphic ischemia. PCR is more cost-effective than CABG.
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Roever L, Liu T, Tse G, Biondi-Zoccai G. Subjective assessment of functional capacity to predict postoperative myocardial injury and death: Hope or hype? Eur J Prev Cardiol 2020; 28:260-261. [PMID: 33611435 DOI: 10.1177/2047487320912624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Leonardo Roever
- Federal University of Uberlândia, Department of Clinical Research, Brazil
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, P.R. China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, P.R. China.,Xiamen Cardiovascular Hospital, P.R. China
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
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Trägårdh E, Tan SS, Bucerius J, Gimelli A, Gaemperli O, Lindner O, Agostini D, Übleis C, Sciagrà R, Slart RH, Underwood SR, Hyafil F, Hacker M, Verberne HJ. Systematic review of cost-effectiveness of myocardial perfusion scintigraphy in patients with ischaemic heart disease: A report from the cardiovascular committee of the European Association of Nuclear Medicine. Endorsed by the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2018; 18:825-832. [PMID: 28549119 DOI: 10.1093/ehjci/jex095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Coronary artery disease (CAD) is a major cause of death and disability. Several diagnostic tests, such as myocardial perfusion scintigraphy (MPS), are accurate for the detection of CAD, as well as having prognostic value for the prediction of cardiovascular events. Nevertheless, the diagnostic and prognostic value of these tests should be cost-effective and should lead to improved clinical outcome. We have reviewed the literature on the cost-effectiveness of MPS in different circumstances: (i) the diagnosis and management of CAD; (ii) comparison with exercise electrocardiography (ECG) and other imaging tests; (iii) as gatekeeper to invasive coronary angiography (ICA), (iv) the impact of appropriate use criteria; (v) acute chest pain, and (vi) screening of asymptomatic patients with type-2 diabetes. In total 57 reports were included. Although most non-invasive imaging tests are cost-effective compared with alternatives, the data conflict on which non-invasive strategy is the most cost-effective. Different definitions of cost-effectiveness further confound the subject. Computer simulations of clinical diagnosis and management are influenced by the assumptions made. For instance, diagnostic accuracy is often defined against an anatomical standard that is wrongly assumed to be perfect. Conflicting data arise most commonly from these incorrect or differing assumptions.
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Affiliation(s)
- Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Lund University and Skåne University Hospital, Inga Marie Nilssons gata 49, 205 02 Malmö, Sweden
| | - Siok Swan Tan
- Erasmus University Rotterdam, Institute for Medical Technology Assessment, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
| | - Jan Bucerius
- Department of Nuclear Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Guiseppe Moruzzi 1, 56124 Pisa, Italy
| | - Oliver Gaemperli
- Cardiac Imaging and Interventional Cardiology, University Heart Centre, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | - Denis Agostini
- Department of Nuclear Medicine, University Hospital of Caen and Normandie Université, Avenue de la Côte de Nacre, 104009 CEDEX 1 Caen, France
| | - Christopher Übleis
- Department of Clinical Radiology, Ludwig-Maximilians Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Riemer H Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Sydney Street, SW3 6NP, London, UK
| | - Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, DHU FIRE, Inserm 1148, University of Paris Diderot, 46 rue Henri Huchard, 75018 Paris, France
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Tilkemeier PL, Bourque J, Doukky R, Sanghani R, Weinberg RL. ASNC imaging guidelines for nuclear cardiology procedures : Standardized reporting of nuclear cardiology procedures. J Nucl Cardiol 2017; 24:2064-2128. [PMID: 28916938 DOI: 10.1007/s12350-017-1057-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
| | - Jamieson Bourque
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rupa Sanghani
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Richard L Weinberg
- Division of Cardiology, University of Michigan Health System, Ann Arbor, MI, USA
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Doukky R, Hayes K, Frogge N. Appropriate use criteria for SPECT myocardial perfusion imaging: Are they appropriate for women? J Nucl Cardiol 2016; 23:695-705. [PMID: 26304956 DOI: 10.1007/s12350-015-0233-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/26/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Several studies have reported that women are more likely to receive inappropriate SPECT myocardial perfusion imaging (MPI), suggesting gender disparity in AUC determination. We investigated the impact of gender on the diagnostic and prognostic utility of AUC. METHODS AND RESULTS We analyzed a multi-site prospective cohort of 1511 consecutive patients (43.5% women) who underwent outpatient, community-based SPECT-MPI. Subjects were stratified into gender groups and appropriateness subgroups, and followed for 27 ± 10 months for cardiac death, myocardial infarction, and coronary revascularization. Women were more likely to receive inappropriate MPI (60.7% vs 33.8%, P < .001). Irrespective of appropriateness, women were less likely to have an abnormal MPI (6.1% vs 14.9%, P < .001), even after adjusting for clinical covariates [odds ratio = 0.40 (95% confidence interval = 0.26-0.60), P < .001]. Irrespective of appropriateness, women were at lower risk for MACE (composite of cardiac death, myocardial infarction, or coronary revascularization) after adjusting for clinical and imaging covariates [hazard ratio = 0.49 (95% confidence interval = 0.28-0.86), P = .01]. There was no interaction between gender and appropriateness group as a determinant of abnormal MPI or MACE (interaction P values ≥ .26), indicating that female gender was associated with similar relative risk of an abnormal MPI and MACE irrespective of appropriateness group. Abnormal MPI was similarly predictive of increased hazard of MACE in both genders, regardless of appropriateness (interaction P values ≥ .46). CONCLUSION In this multi-site cohort, there was no demonstrable gender-based differential impact of AUC on the diagnostic or prognostic utility of SPECT-MPI. The study validates the methods used in determining risk in the AUC algorithm and endorses the widespread application of AUC in men and women.
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Affiliation(s)
- Rami Doukky
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St, Suite 3620, Chicago, 60612, IL, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| | - Kathleen Hayes
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Nathan Frogge
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
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