title: Impact of advanced exercise ECG analysis on cost of coronary artery disease management.
abstract: BACKGROUND
  Conventional analysis of exercise electrocardiogram (EX-ECG) has limited accuracy. This study aims to evaluate the potential impact of improving EX-ECG accuracy on costs of diagnosis and number of misdiagnoses of coronary artery disease (CAD).
  
  
  METHODS
  A decision-tree model was simulated including sequential application of diagnostic procedures for suspected CAD. The model was structured in two main branches (presence or absence of CAD). A probabilistic sensitivity analysis was then performed for several combinations of improvement in test sensitivity and specificity.
  
  
  RESULTS
  A clear trend in cost reduction was observed at improving EX-ECG specificity (about 8-8.5 million dollars, corresponding to a 5.6-7.6% reduction according to the prevalence level). Wrong diagnoses counted for 9-13% of test. Improvements in test parameters lead to reductions in wrong diagnoses, especially when increasing specificity (8.8-12.5%).
  
  
  CONCLUSIONS
  A proper improvement in EX-ECG sensitivity and specificity would have a relevant impact on the costs of CAD management, while reducing the number of misdiagnoses.
authors.affiliation: Cardiology, Department of Medicine and Surgery, University School of Medicine, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bigi
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrando
authors.forename: Eva
authors.initials: E
authors.lastname: Pagano
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics*; D003365:Costs and Cost Analysis; D003663:Decision Trees; D019468:Disease Management; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D006801:Humans; D008962:Models, Theoretical; D009010:Monte Carlo Method