title: Clinical impact and cost-effectiveness of coronary computed tomography angiography or exercise electrocardiogram in individuals without known cardiovascular disease.
abstract: It is not clear whether screening by coronary computed tomographic angiography (CCTA) and/or exercise electrocardiogram (ECG) can improve clinical outcomes and reduce costs in individuals without known cardiovascular disease (CVD). In total, 71,811 consecutive individuals without known CVD who underwent general health examinations were enrolled. Using propensity-score matching according to screening tests, 1-year clinical outcomes and 6-month total and coronary artery disease-related medical costs were analyzed in separate groups: group 1 (CCTA [n = 2578] vs no screening [n = 5146]), group 2 (exercise ECG [n = 2898] vs no screening [n = 5796]), and group 3 (CCTA and exercise ECG [n = 2003] vs no screening [n = 4006]). There were no significant differences in the composite outcome of death, myocardial infarction, and stroke in each matched group: group 1 (0.35% vs 0.45%, P = 0.501), group 2 (0.14% vs 0.28%, P = 0.157), and group 3 (0.25% vs 0.27%, P = 0.858). However, revascularization was more frequent in the CCTA screening groups: group 1 (2.02% vs 0.45%, P < 0.001) and group 3 (1.40% vs 0.45%, P < 0.001). Matched screening groups had higher 6-month total and coronary artery disease-related medical costs: group 1 ($777 vs $603, P < 0.001 and $177 vs $39, P < 0.001), group 2 ($544 vs $492, P = 0.045 and $12 vs $15, P = 0.611), and group 3 ($705 vs $627, P = 0.090 and $135 vs $35, P < 0.001). In individuals without known CVD, CCTA screening with or without exercise ECG led to more frequent revascularization at the expense of higher medical costs, but did not decrease the 1-year risk of death, myocardial infarction, and stroke.
authors.affiliation: From the Department of Cardiology (G-MP, SHH), Daejeon St Mary's Hospital, The Catholic University of Korea, Daejeon, Korea; Department of Nursing (SHK), College of Medicine, Dankook University, Cheonan; Departments of Cardiology (J-MA, D-WP, S-JK, S-WL, Y-HK, CWL, S-WP, S-JP), Preventive Medicine (M-WC), Endocrinology (B-JK, J-MK), and the Health Screening and Promotion Center (H-KK, JC), Asan Medical Center, University of Ulsan College of Medicine, Seoul; and Department of Applied Statistics (SH), Gachon University, Seongnam, Korea.
authors.forename: Gyung-Min
authors.initials: GM
authors.lastname: Park
authors.forename: Seon Ha
authors.initials: SH
authors.lastname: Kim
authors.forename: Min-Woo
authors.initials: MW
authors.lastname: Jo
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Her
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Beom-Jun
authors.initials: BJ
authors.lastname: Kim
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Koh
authors.forename: Hong-Kyu
authors.initials: HK
authors.lastname: Kim
authors.forename: Jaewon
authors.initials: J
authors.lastname: Choe
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D001837:Body Weights and Measures; D017023:Coronary Angiography / Q000191:economics*; D001026:Coronary Artery Bypass / Q000191:economics; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D005080:Exercise Test / Q000191:economics*; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D012307:Risk Factors; D012959:Socioeconomic Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*