Cost-effectiveness of coronary computed tomography and cardiac stress imaging in the emergency department: A decision analytic model comparing diagnostic strategies for chest pain in patients at low risk of acute coronary syndromes

Priest, Virginia L., Scuffham, Paul A., Hachamovitch, Rory and Marwick, Thomas H. (2011) Cost-effectiveness of coronary computed tomography and cardiac stress imaging in the emergency department: A decision analytic model comparing diagnostic strategies for chest pain in patients at low risk of acute coronary syndromes. JACC: Cardiovascular Imaging, 4 5: 549-556. doi:10.1016/j.jcmg.2011.03.008

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Author Priest, Virginia L.
Scuffham, Paul A.
Hachamovitch, Rory
Marwick, Thomas H.
Title Cost-effectiveness of coronary computed tomography and cardiac stress imaging in the emergency department: A decision analytic model comparing diagnostic strategies for chest pain in patients at low risk of acute coronary syndromes
Journal name JACC: Cardiovascular Imaging   Check publisher's open access policy
ISSN 1876-7591
1936-878X
Publication date 2011-05
Sub-type Article (original research)
DOI 10.1016/j.jcmg.2011.03.008
Volume 4
Issue 5
Start page 549
End page 556
Total pages 8
Place of publication New York, NY, U.S.A.
Publisher Elsevier
Collection year 2012
Language eng
Formatted abstract
Emergency department presentations with chest pain are expensive and often unrelated to coronary artery disease (CAD). Coronary computed tomographic angiography (CTA) may allow earlier discharge of low-risk patients, resulting in cost savings. We modeled clinical and economic outcomes of diagnostic strategies in patients with chest pain and at low risk of CAD: exercise electrocardiography (ECG), stress single-photon emission computed tomography (SPECT), stress echocardiography, and a CTA strategy comprising an initial CTA scan with confirmatory SPECT for indeterminate results. Our results suggest that a 2-step diagnostic strategy of CTA with SPECT for intermediate scans is likely to be less costly and more effective for the diagnosis of a patient group at low risk of CAD and a prevalence of 2% to 30%. The CTA strategies were cost saving (lower costs, higher quality-adjusted life-years) compared with stress ECG, echocardiography, and SPECT. Confirming intermediate/indeterminate CTA scans with SPECT results in cost savings and quality-adjusted life-year gains due to reduced hospitalization of patients who returned false-positive initial CTA test. However, CTA may be associated with a higher event rate in negative patients than SPECT, and the diagnostic and prognostic information for the use of CTA in the emergency department is evolving. Large comparative, randomized, controlled trials of the different diagnostic strategies are needed to compare the long-term costs and consequences of each strategy in a population of defined low-risk patients in the emergency department.
Keyword Chest pain
Coronary computed tomographic angiography
Cost-effectiveness
Echocardiography
Single-photon emission computed tomography
Stress electrocardiography
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Mon, 05 Sep 2011, 11:02:26 EST by Matthew Lamb on behalf of School of Medicine