title: Cost-effectiveness analysis of 64-slice computed tomography vs. cardiac catheterization to rule out coronary artery disease before non-coronary cardiovascular surgery.
abstract: OBJECTIVE
  To explore the cost-effectiveness of two alternative strategies to rule out significant coronary artery disease (CAD) in the pre-operative evaluation of non-coronary cardiovascular surgery: initial pre-operative coronary 64-slice computed tomography angiography (CCTA) vs. invasive coronary angiography (ICA).
  
  
  RESULTS
  These diagnostic strategies are compared from the clinical and payee's perspective, on the basis of the results of four European studies including 490 patients, by an analytic model of a decision tree in terms of the cost-effectiveness as the percentage of catheterizations, complications, and deaths avoided. These studies show that 71.2% of the ICA and 3.56% of the post-ICA complications could have been avoided by an initial pre-operative CCTA with a saving of €411/patient. The sensitivity analysis did not find relevant differences in terms of the cost-effectiveness when we established the indication of ICA vs. CCTA in relation to the amount of coronary calcium and when ICA was always performed by radial access. However, the lack of team experience in CCTA increased the economical and biological cost due to involving an ICA and the exposure to double ionizing radiation sources.
  
  
  CONCLUSIONS
  In experienced groups, the diagnostic strategy with initial pre-operative CCTA is better than the strategy with initial ICA because it is capable of ruling out significant CAD avoiding ICA and post-ICA morbidity-mortality, with an important saving in the cost of the diagnostic process.
authors: Cardiology Department, Ramón y Cajal University Hospital (Madrid), Ctra. Colmenar Km 9,100, 28034 Madrid, Spain. mcatalan.hrc@salud.madrid.org
authors: Paz
authors: P
authors: Catalán
authors: Daniel
authors: D
authors: Callejo
authors: Juan Antonio
authors: JA
authors: Blasco
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000191:economics* / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000191:economics* / Q000379:methods; D011300:Preoperative Care / Q000379:methods