Cost-effectiveness of exercise stress testing performed as part of executive health examinations.
BACKGROUND
An executive health examination is offered at many hospitals for "busy executives" that comprises of a typical history and examination along with screening tests for major cardiovascular and respiratory illnesses. Exercise stress tests are also frequently included in such packages, though the appropriateness of such stress testing remains uncertain.


OBJECTIVE
To assess the appropriateness and cost-effectiveness of exercise stress tests performed as part of executive health examinations.


METHODS
Records of all individuals who underwent an executive health examination at our institution between January, 2007 and December, 2012 were retrospectively reviewed. Data were collected pertaining to demographics, cardiovascular risk factors, indication of stress testing and results of exercise stress tests.


RESULTS
Of a total of 1650 subjects who underwent exercise stress tests as part of executive health examinations, indication for exercise stress testing was class IIb or III (as per American College of Cardiology's appropriateness criteria) in 96.1 % of subjects. The cumulative cost and time burden of testing for these subjects were Rs. 11,419,200/- PKR (≈$114,192 USD) and 2 weeks and 4 days, respectively. Exercise stress tests were not positive for ischemia in any such cases.


CONCLUSIONS
Based on the results of this study, exercise stress tests should not be routinely offered as part of executive health examinations.
Department of Biological and Biomedical Sciences, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.
S J
SJ
Shah
Department of Biological and Biomedical Sciences, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan. jsmawais@yahoo.com.|Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. jsmawais@yahoo.com.
A
A
Rehman
Department of Biological and Biomedical Sciences, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.
M H S
MHS
Shaukat
Department of Radiology, The Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.
M
M
Awais
D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005080:Exercise Test / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
Cardiopulmonary exercise test; Cost-benefit data; Executive health examination; Periodic health evaluation