Noninvasive imaging for the diagnosis of coronary artery disease: focusing the development of new diagnostic technology.
BACKGROUND
New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease.


OBJECTIVE
To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests.


METHODS
Decision model and cost-effectiveness analysis.


METHODS
Literature review and meta-analysis.


METHODS
55-year-old men and 65-year-old women presenting with chest pain.


METHODS
Lifetime of the patient.


CONCLUSIONS
Health care policy.


METHODS
MRI, electron-beam CT, exercise echocardiography, exercise single-photon emission CT, and coronary angiography.


METHODS
Target sensitivity and specificity values for a new noninvasive test.


RESULTS
Assuming that society is willing to pay $75000 per quality-adjusted life-year (QALY) gained, a new test that costs $1000 would need a sensitivity of 94% and a specificity of 90% to be cost-effective.


RESULTS
Assuming that society is willing to pay $50000 per QALY gained, a new test that costs $1000 or more would never be cost-effective. For a test that costs $500, the sensitivity and specificity must each be 95%.


CONCLUSIONS
New imaging techniques, such as MRI and electron-beam CT, must be relatively inexpensive and have excellent sensitivity and specificity to be cost-effective compared with other techniques for the diagnosis of coronary artery disease. Similar analyses in other areas of health care may help to focus the development of new diagnostic technology.
Hunink
M G
MG
Erasmus Medical Center Rotterdam, The Netherlands. hunink@epib.fgg.eur.nl
Kuntz
K M
KM
Fleischmann
K E
KE
Brady
T J
TJ
D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000191:economics*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008390:Markov Chains; D013677:Medical Laboratory Science / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics