title: Cost-effectiveness of coronary CT angiography in patients with chest pain: Comparison with myocardial single photon emission tomography.
abstract: BACKGROUND
  Coronary CT angiography (CCTA) has been proven accurate and is incorporated in clinical recommendations for coronary artery disease (CAD) diagnosis workup, but cost-effectiveness data, especially in comparison to other methods such as myocardial single photon emission CT (SPECT) are insufficient.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of CCTA and myocardial SPECT in a real-world setting.
  
  
  METHODS
  We performed a retrospective cohort study on consecutive patients with suspected CAD and a pretest probability between 10% and 90%. Test accuracy was compared by correcting referral bias to coronary angiography depending on noninvasive test results based on the Bayes' theorem and also by incorporating 1-year follow-up results. Cost-effectiveness was analyzed using test accuracy and quality-adjusted life year (QALY). The model using diagnostic accuracy used the number of patients accurately diagnosed among 1000 persons as the effect and contained only expenses for diagnostic testing as the cost. In the model using QALY, a decision tree was developed, and the time horizon was 1 year.
  
  
  RESULTS
  CCTA was performed in 635 patients and SPECT in 997 patients. An accurate diagnosis per 1000 patients was achieved in 725 patients by CCTA vs 661 patients by SPECT. In the model using diagnostic accuracy, CCTA was more effective and less expensive than SPECT ($725.38 for CCTA vs $661.46 for SPECT). In the model using QALY, CCTA was generally more effective in terms of life quality (0.00221 QALY) and cost ($513) than SPECT. However, cost utility varied among subgroups, with SPECT outperforming CCTA in patients with a pretest probability of 30% to 60% (0.01890 QALY; $113).
  
  
  CONCLUSIONS
  These results suggest that CCTA may be more cost-effective than myocardial SPECT.
authors.affiliation: Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Information Statistics, Andong National University, Andong-si, Korea.
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Jang
authors.affiliation: Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Myung-Jin
authors.initials: MJ
authors.lastname: Cha
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; School of Pharmacy, Sungkyunkwan University, Suwon-si, Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; School of Pharmacy, Sungkyunkwan University, Suwon-si, Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Song
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Choi
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Jung-Im
authors.initials: JI
authors.lastname: Shim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Jeonghoon
authors.initials: J
authors.lastname: Ahn
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Korea. Electronic address: hjleedr@gmail.com.
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics* / Q000209:etiology; D017023:Coronary Angiography / Q000191:economics*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011237:Predictive Value of Tests; D019057:Quality-Adjusted Life Years; D056910:Republic of Korea; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics*
keywords: Coronary artery disease; Coronary computed tomography angiography; Cost-effectiveness; Myocardial single photon emission computed tomography