OBIECTIVES The purpose of this study was to determine if electron beam computed tomography (EBCT) has potential as a cost-effective approach to diagnosis of obstructive coronary disease.
BACKGROUND Coronary calcification quantified by EBCT is closely related to the extent of atherosclerosis.
METHODS A model based upon published sensitivities (Se)/specificities (Sp) for diagnosis in an ambulatory patient of obstructive coronary disease (>50% stenosis) and population prevalence was tested for angiography alone, or treadmill exercise, stress echocardiography, stress thallium or predetermined EBCT calcium score outpoints, followed by angiography if indicated.
RESULTS Total direct testing costs increased in proportion to disease prevalence whereas cost-effectiveness, direct costs/patient diagnosed correctly with disease, decreased as a function of prevalence.
Using an EBCT calcium score of 168 (Se/Sp=71%/90%) provided for the least costly and most cost-effective noninvasive pathway.
Calcium scores of 80 (Se/Sp=84%/84%) and 37 (Se/Sp=90%/77%) were also cost-elective when prevalence of disease was<70% ; but results for a>0 calcium score (Se/Sp=95%/46%) cutpoint were not superior to conventional methods.
Calcium score cutpoints of 37,80 or 168 provided similar or superior overall negative and positive predictive values to conventional noninvasive testing pathways across all prevalence subgroups. (...)
Mots-clés Pascal : Tomodensitométrie, Faisceau électronique, Exploration, Occlusion, Artère coronaire, Calcification, Homme, Coût, Economie santé, Diagnostic, Etude comparative, Méthode non invasive, Radiodiagnostic, Imagerie médicale, Cardiopathie coronaire, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie
Mots-clés Pascal anglais : Computerized axial tomography, Electron beam, Exploration, Occlusion, Coronary artery, Calcification, Human, Costs, Health economy, Diagnosis, Comparative study, Non invasive method, Radiodiagnosis, Medical imagery, Coronary heart disease, Cardiovascular disease, Vascular disease, Arterial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0118777
Code Inist : 002B24A03. Création : 16/11/1999.