Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain.
BACKGROUND
Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients.


METHODS
We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6).


RESULTS
The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5x, of a ex-SPECT-Tc is 3.1x, of a ex-ECG is 3.5x, of cTnI is x3.8, of cTnT is x3.9 and of a CA is 56.3x.


CONCLUSIONS
Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void.
Hospital S, Maria della Scaletta, Imola, Italy. gigliola.bedetti@tin.it
Gigliola
G
Bedetti
Emilio Maria
EM
Pasanisi
Carmine
C
Pizzi
Giuseppe
G
Turchetti
Cosimo
C
Loré
D002637:Chest Pain / Q000175:diagnosis* / Q000191:economics; D015331:Cohort Studies; D017023:Coronary Angiography / Q000191:economics; D003327:Coronary Disease / Q000175:diagnosis / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003935:Diagnostic Techniques, Cardiovascular / Q000191:economics*; D025401:Echocardiography, Stress / Q000191:economics; D004562:Electrocardiography / Q000191:economics; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007558:Italy; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics