Diagnosis of suspected coronary artery disease in women: a cost-effectiveness analysis.
BACKGROUND
The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost-effectiveness of several strategies for diagnosing CAD in women with chest pain.


METHODS
We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup.


RESULTS
Diagnosis with angiography cost less than $17, 000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing.


CONCLUSIONS
Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost-effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality-adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55-year-old women with probable angina and nonspecific chest pain.
Kim
C
C
Department of Medicine and the Division of Cardiology, University of California, San Francisco, CA 94131-0214, USA.
Kwok
Y S
YS
Saha
S
S
Redberg
R F
RF
D000787:Angina Pectoris / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data; D002140:California; D002637:Chest Pain / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D001026:Coronary Artery Bypass / Q000191:economics / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity