Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain

Shaw, LJ, Marwick, TH, Berman, DS, Sawada, S, Heller, GV, Vasey, C and Miller, DD (2006) Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain. European Heart Journal, 27 20: 2448-2458. doi:10.1093/eurheartj/ehl204

Author Shaw, LJ
Marwick, TH
Berman, DS
Sawada, S
Heller, GV
Vasey, C
Miller, DD
Title Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain
Journal name European Heart Journal   Check publisher's open access policy
ISSN 0195-668X
Publication date 2006-01-01
Sub-type Article (original research)
DOI 10.1093/eurheartj/ehl204
Open Access Status Not yet assessed
Volume 27
Issue 20
Start page 2448
End page 2458
Total pages 11
Editor F. Van de Werf
Place of publication UK
Publisher Oxford University Press
Language eng
Subject C1
321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
Abstract Aims Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. Methods and results We examined prognosis and cost-effectiveness of exercise echocardiography (n=4884) vs. SPECT (n=4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio <$50 000 per life year saved (LYS) was considered favourable for economic efficiency. The risk-adjusted 3-year death or MI rates classified by extent of ischaemia were similar, ranging from 2.3 to 8.0% for echocardiography and from 3.5 to 11.0% for SPECT (model chi(2)=216; P < 0.0001; interaction P=0.24). Cost-effectiveness ratios for echocardiography were <$20 000/LYS when the annual risk of death or MI was < 2%. However, when yearly cardiac event rate were > 2%, cost-effectiveness ratios for echocardiography vs. SPECT were in the range of $66 686-$419 522/LYS. For patients with established coronary disease (i.e. >= 2% annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of $32 381/LYS. Conclusion Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.
Keyword Cardiac & Cardiovascular Systems
Cost Effectiveness
Stable Angina
Emission Computed-tomography
Myocardial-perfusion Scintigraphy
Association Task-force
Prognostic Value
Stress Echocardiography
Risk Stratification
Practice Guidelines
Nuclear Cardiology
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 39 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 55 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 19:58:16 EST