title: Economic impact of contrast stress echocardiography on the diagnosis and initial treatment of patients with suspected coronary artery disease.
abstract: OBJECTIVE
  To estimate the impact of contrast stress echocardiography on resource use in the treatment of patients with suspected coronary artery disease (CAD).
  
  
  METHODS
  Fifty-nine patients with suspected CAD underwent nuclear perfusion imaging and contrast echocardiography examination. Further treatment was planned after each test and a final treatment was recommended after reviewing the results of both examinations. Medical resources and productivity losses were then collected for a 3-month follow-up period.
  
  
  RESULTS
  Diagnosis was possible in 96.6% of patients with nuclear perfusion imaging and 93.2% with contrast echocardiography, resulting in a cost per successful diagnosis of $637 (Can) and $476 (Can), respectively. For the majority of patients (74%), both tests provided the same result, but for 12 patients nuclear imaging suggested abnormal perfusion, whereas contrast echocardiography indicated normal function and for 2 patients it was the opposite situation. Per-patient costs for the total patient population decreased from $316 (Can) after nuclear perfusion imaging to $250 (Can) when results from both tests were known. Three-month follow-up societal costs were $441 (Can) per patient, with hospitalization contributing 58% of this total cost.
  
  
  CONCLUSIONS
  Contrast echocardiography has a similar success rate to nuclear perfusion imaging in diagnosing CAD, but has a 28% lower cost and has the potential of additional cost savings through the elimination of further diagnostic tests.
authors.affiliation: Montreal Heart Institute, Montreal, Quebec, Canada. tardifjc@icm.umontreal.ca
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: Annie
authors.initials: A
authors.lastname: Dore
authors.forename: Kwan L
authors.initials: KL
authors.lastname: Chan
authors.forename: Sue
authors.initials: S
authors.lastname: Fagan
authors.forename: Georges
authors.initials: G
authors.lastname: Honos
authors.forename: François
authors.initials: F
authors.lastname: Marcotte
authors.forename: Eric
authors.initials: E
authors.lastname: Yu
authors.forename: Samuel
authors.initials: S
authors.lastname: Siu
authors.forename: Jean
authors.initials: J
authors.lastname: Dumesnil
authors.forename: Marie
authors.initials: M
authors.lastname: Arsenault
authors.forename: Chris
authors.initials: C
authors.lastname: Koilpillai
authors.forename: Franco
authors.initials: F
authors.lastname: D'onofrio
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine