title: Role of MDCT coronary angiography in the clinical setting: economic implications.
abstract: OBJECTIVE
  This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup.
  
  
  METHODS
  Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary).
  
  
  RESULTS
  Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol.
  
  
  CONCLUSIONS
  The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.
authors.affiliation: Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy, rmalag@sirm.org.
authors.forename: Roberto
authors.initials: R
authors.lastname: Malagò
authors.forename: Andrea
authors.initials: A
authors.lastname: Pezzato
authors.forename: Camilla
authors.initials: C
authors.lastname: Barbiani
authors.forename: Domenico
authors.initials: D
authors.lastname: Tavella
authors.forename: Paola
authors.initials: P
authors.lastname: Vallerio
authors.forename: Anna Fratta
authors.initials: AF
authors.lastname: Pasini
authors.forename: Luciano
authors.initials: L
authors.lastname: Cominacini
authors.forename: Roberto Pozzi
authors.initials: RP
authors.lastname: Mucelli
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000191:economics*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000191:economics*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity