title: Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country.
abstract: Myocardial perfusion imaging is widely used for the risk stratification of coronary artery disease. In view of its cost, besides radiation issues, judicious evaluation of the appropriateness of its indications is essential to prevent an unnecessary economic burden on the health system. We evaluated, at a tertiary-care, public Brazilian hospital, the appropriateness of myocardial perfusion scintigraphy indications, and estimated the budget impact of applying appropriateness criteria. An observational, cross-sectional study of 190 patients with suspected or known coronary artery disease referred for myocardial perfusion imaging was conducted. The appropriateness of myocardial perfusion imaging indications was evaluated with the Appropriate Use Criteria for Cardiac Radionuclide Imaging published in 2009. Budget impact analysis was performed with a deterministic model. The prevalence of appropriate requests was 78%; of inappropriate indications, 12%; and of uncertain indications, 10%. Budget impact analysis showed that the use of appropriateness criteria, applied to the population referred to myocardial perfusion scintigraphy within 1 year, could generate savings of $ 64,252.04 dollars. The 12% inappropriate requests for myocardial perfusion scintigraphy at a tertiary-care hospital suggest that a reappraisal of MPI indications is needed. Budget impact analysis estimated resource savings of 18.6% with the establishment of appropriateness criteria for MPI.
authors.affiliation: Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil.
authors.forename: Mauro Augusto
authors.initials: MA
authors.lastname: Dos Santos
authors.affiliation: Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil.
authors.forename: Marisa Silva
authors.initials: MS
authors.lastname: Santos
authors.affiliation: Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil.
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.affiliation: Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Félix
authors.affiliation: Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil.
authors.forename: Adriana Soares X
authors.initials: ASX
authors.lastname: Brito
authors.affiliation: Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil. andlorenzo@hotmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Lorenzo
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002017:Budgets / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics* / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: Myocardial perfusion imaging: SPECT; coronary artery disease; cost effectiveness; diagnostic and prognostic application