title: Cost-effectiveness analysis of noninvasive strategies to evaluate patients with chest pain.
abstract: We evaluated clinical and economic outcomes of diagnostic strategies on the basis of pharmacologic stress echocardiography (PhSE) versus exercise electrocardiography test (EET) in 527 patients with chest pain (274 women; age 59 +/- 10 years) who underwent both EET and PhSE. We investigated 3 strategies, ie, coronary angiography: after positive EET (strategy 1); after positive PhSE (strategy 2); or after a positive PhSE performed after a positive EET (strategy 3). A patient was correctly identified if he or she had negative test results and no events, or had positive test results and abnormal coronaries. The cost per patient correctly identified was calculated as the ratio between the cost of each strategy and the number of patients correctly identified. The accuracy in correctly identifying the patients was 78%, 92%, and 91% with strategies 1, 2, and 3, respectively. The cost of each patient correctly identified was 1572 US dollars, 1097 US dollars, and 1081 US dollars with strategies 1, 2, and 3, respectively. In conclusion, PhSE-based strategies are cost-effective versus EET.
authors.affiliation: UO Malattie Cardiovasculari, Ospedale Campo di Marte, Lucca, Italy. lorenzoni.r@tin.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorenzoni
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Mirco
authors.initials: M
authors.lastname: Magnani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Desideri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bigi
authors.forename: Costantina
authors.initials: C
authors.lastname: Manes
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis*; D017023:Coronary Angiography / Q000191:economics*; D003362:Cost-Benefit Analysis; D004176:Dipyridamole; D025401:Echocardiography, Stress / Q000191:economics*; D004562:Electrocardiography / Q000191:economics*; D005080:Exercise Test / Q000191:economics; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged
chemical_list: D004176:Dipyridamole