title: [Cost-effectiveness analysis of nuclear cardiology and its impact on total expense for diagnosis of coronary artery disease].
abstract: BACKGROUND
  Medical care in a hospital under a socialized medicine system should be highly effective at the lowest expense possible. When myocardial perfusion studies are performed in well-selected patients, the costs decrease because of the need for fewer invasive studies. When patients are not selected properly, there is an increase-wasted resource, making it necessary to perform cost-effective studies. The goal of this study is to evaluate the economical impact of the diagnostic process in patients suspected of having coronary artery disease, referred to our service (Nuclear Medicine, Hospital de Cardiología CMN, IMSS) in 2002.
  
  
  METHODS
  We analyzed 1966 reports of myocardial gammagrams. Patient reports were stratified according to their referring unit. The sum of the unitary fixed cost was converted to the unitary cost for each reason for referral. Kappa was used to evaluate concordance.
  
  
  RESULTS
  Patients were 62 +/- 11.39 years old, 52% male. Concordance between the referring diagnosis and the myocardial gammagram was <1% (p <0.001). The cost of cardiac gammagrams varied between $2,613.11 and $3,306.77 (Mexican pesos). Waste was calculated at 30%, which represented $1.8 million (Mexican pesos).
  
  
  CONCLUSIONS
  Cost-effective studies are important tools in the administration of resources. In this particular case the results indicate the necessity for systematic registration of financial information, periodic review of operation costs by service, and criteria for use of high-cost services.
authors.affiliation: Servicio de Cardiología Nuclear, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS. almavale@terra.com.mx
authors.forename: Alma Gabriela
authors.initials: AG
authors.lastname: Valenzuela-Flores
authors.forename: Adriana Abigail
authors.initials: AA
authors.lastname: Valenzuela-Flores
authors.forename: Héctor
authors.initials: H
authors.lastname: Arreola-Ornelas
authors.forename: Israel
authors.initials: I
authors.lastname: Calderón-Orozco
authors.forename: José C
authors.initials: JC
authors.lastname: Valdés-Durón
authors.forename: J Pascual
authors.initials: JP
authors.lastname: Pérez-Campos
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D011875:Radionuclide Angiography / Q000191:economics*