Ferreira AM, Marques H, Gonçalves PA, Cardim N. Cost-effectiveness of different diagnostic strategies in suspected stable coronary artery disease in Portugal.
Arq Bras Cardiol 2014;
102:391-402. [PMID:
24844876 PMCID:
PMC4023916 DOI:
10.5935/abc.20140042]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 12/10/2013] [Indexed: 11/20/2022] Open
Abstract
Background
Cost-effectiveness is an increasingly important factor in the choice of a
test or therapy.
Objective
To assess the cost-effectiveness of various methods routinely used for the
diagnosis of stable coronary disease in Portugal.
Methods
Seven diagnostic strategies were assessed. The cost-effectiveness of each
strategy was defined as the cost per correct diagnosis (inclusion or
exclusion of obstructive coronary artery disease) in a symptomatic patient.
The cost and effectiveness of each method were assessed using Bayesian
inference and decision-making tree analyses, with the pretest likelihood of
disease ranging from 10% to 90%.
Results
The cost-effectiveness of diagnostic strategies was strongly dependent on the
pretest likelihood of disease. In patients with a pretest likelihood of
disease of ≤50%, the diagnostic algorithms, which include cardiac computed
tomography angiography, were the most cost-effective. In these patients,
depending on the pretest likelihood of disease and the willingness to pay
for an additional correct diagnosis, computed tomography angiography may be
used as a frontline test or reserved for patients with positive/inconclusive
ergometric test results or a calcium score of >0. In patients with a
pretest likelihood of disease of ≥ 60%, up-front invasive coronary
angiography appears to be the most cost-effective strategy.
Conclusions
Diagnostic algorithms that include cardiac computed tomography angiography
are the most cost-effective in symptomatic patients with suspected stable
coronary artery disease and a pretest likelihood of disease of ≤50%. In
high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive
coronary angiography appears to be the most cost-effective strategy. In all
pretest likelihoods of disease, strategies based on ischemia appear to be
more expensive and less effective compared with those based on anatomical
tests.
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