title: The cost-effectiveness of cardiac computed tomography for patients with stable chest pain.
abstract: OBJECTIVE
  To assess the cost-effectiveness of cardiac CT compared with exercise stress testing (EST) in improving the health-related quality of life of patients with stable chest pain.
  
  
  METHODS
  A cost-utility analysis alongside a single-centre randomised controlled trial carried out in Northern Ireland. Patients with stable chest pain were randomised to undergo either cardiac CT assessment or EST (standard care). The main outcome measure was cost per quality adjusted life year (QALY) gained at 1 year.
  
  
  RESULTS
  Of the 500 patients recruited, 250 were randomised to cardiac CT and 250 were randomised to EST. Cardiac CT was the dominant strategy as it was both less costly (incremental total costs -£50.45; 95% CI -£672.26 to £571.36) and more effective (incremental QALYs 0.02; 95% CI -0.02 to 0.05) than EST. At a willingness-to-pay threshold of £20 000 per QALY the probability of cardiac CT being cost-effective was 83%. Subgroup analyses indicated that cardiac CT appears to be most cost-effective in patients with a likelihood of coronary artery disease (CAD) of <30%, followed by 30%-60% and then >60%.
  
  
  CONCLUSIONS
  Cardiac CT is cost-effective compared with EST and cost-effectiveness was observed to vary with likelihood of CAD. This finding could have major implications for how patients with chest pain in the UK are assessed, however it would need to be validated in other healthcare systems.
  
  
  BACKGROUND
  (ISRCTN52480460); results.
authors.affiliation: Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Agus
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
authors.forename: P
authors.initials: P
authors.lastname: McKavanagh
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK.
authors.forename: L
authors.initials: L
authors.lastname: Lusk
authors.affiliation: Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Verghis
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Walls
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Ball
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK.
authors.forename: T R
authors.initials: TR
authors.lastname: Trinick
authors.affiliation: Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Harbinson
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Donnelly
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000191:economics* / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005080:Exercise Test / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D011237:Predictive Value of Tests; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*