title: Economic evaluation of increasing population rates of cardiac catheterization.
abstract: BACKGROUND
  Increasing population rates of cardiac catheterization can lead to the detection of more people with high risk coronary disease and opportunity for subsequent revascularization. However, such a strategy should only be undertaken if it is cost-effective.
  
  
  METHODS
  Based on data from a cohort of patients undergoing cardiac catheterization, and efficacy data from clinical trials, we used a Markov model that considered 1) the yield of high-risk cases as the catheterization rate increases, 2) the long-term survival, quality of life and costs for patients with high risk disease, and 3) the impact of revascularization on survival, quality of life and costs. The cost per quality-adjusted life year was calculated overall, and by indication, age, and sex subgroups.
  
  
  RESULTS
  Increasing the catheterization rate was associated with a cost per QALY of CAN$26,470. The cost per QALY was most attractive in females with Acute Coronary Syndromes (ACS) ($20,320 per QALY gained), and for ACS patients over 75 years of age ($16,538 per QALY gained). However, there is significant model uncertainty associated with the efficacy of revascularization.
  
  
  CONCLUSIONS
  A strategy of increasing cardiac catheterization rates among eligible patients is associated with a cost per QALY similar to that of other funded interventions. However, there is significant model uncertainty. A decision to increase population rates of catheterization requires consideration of the accompanying opportunity costs, and careful thought towards the most appropriate strategy.
authors: Department of Medicine, Faculty of Medicine, University of Calgary, Foothills Medical Centre-North Tower, 9th Floor, 1403-29th Street NW, Calgary, AB T2N 2T9, Canada.
authors: Fiona M
authors: FM
authors: Clement
authors: William A
authors: WA
authors: Ghali
authors: Stephane
authors: S
authors: Rinfret
authors: Braden J
authors: BJ
authors: Manns
mesh_terms: D000328:Adult; D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data* / Q000639:trends; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000592:standards; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D016011:Normal Distribution; D009674:Nova Scotia / Q000453:epidemiology; D011788:Quality of Life; D018570:Risk Assessment