title: Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.
abstract: BACKGROUND
  PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing.
  
  
  OBJECTIVE
  To conduct an economic analysis for PROMISE (a major secondary aim of the study).
  
  
  METHODS
  Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550).
  
  
  METHODS
  190 U.S. centers.
  
  
  METHODS
  9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months.
  
  
  METHODS
  Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods.
  
  
  RESULTS
  The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, -$634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small.
  
  
  CONCLUSIONS
  Cost weights for test strategies were obtained from sources outside PROMISE.
  
  
  CONCLUSIONS
  Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.
  
  
  BACKGROUND
  National Heart, Lung, and Blood Institute.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Federspiel
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cowper
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: Linda
authors.initials: L
authors.lastname: Davidson-Ray
authors.forename: Melanie R
authors.initials: MR
authors.lastname: Daniels
authors.forename: Lawton S
authors.initials: LS
authors.lastname: Cooper
authors.forename: J David
authors.initials: JD
authors.lastname: Knight
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography / Q000191:economics; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D025401:Echocardiography, Stress / Q000191:economics; D004562:Electrocardiography / Q000191:economics; D005080:Exercise Test / Q000191:economics / Q000379:methods; D005251:Fees, Medical; D005260:Female; D006334:Heart Function Tests / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000191:economics*; D011446:Prospective Studies