The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients : An observational assessment of the value of precatheterization ischemia.
OBJECTIVES The study aim was to determine observational differences in costs of care by the coronary disease diagnostic test modality BACKGROUND A number of diagnostic strategies arc available with few data to compare the cost implications of the initial test choice.
METHODS We prospectively enrolled 11,372 consecutive stable angina patients who were referred for stress myocardial perfusion tomography or cardiac catheterization.
Stress imaging patients were matched by their pretest clinical risk of coronary disease to a series of patients referred to cardiac catheterization.
Composite 3-year costs of care were compared for two patients management strategies : 1) direct cardiac catheterization (aggressive) and 2) initial stress myocardial perfusion tomography and selective catheterization of high risk patients (conservative).
Analysis of variance techniques were used to compare costs, adjusting for treatment propensity and pretest risk RESULTS Observational comparisons of aggressive as compared with conservative testing strategies reveal that costs of care were higher for direct cardiac catheterization in all clinical risk subsets (range : $2,878 to $4,579), as compared with stress myocardial perfusion imaging plus selective catheterization (range : $2,387 to $3,010, p<0.0001).
Coronary revascularization rates were higher for low, intermediate and high risk direct catheterization patients as compared with the initial stress perfusion imaging cohort (13% to 50%, p<0. (...)
Mots-clés Pascal : Angine poitrine, Tomoscintigraphie, Epreuve effort, Analyse coût efficacité, Economie santé, Diagnostic, Pronostic, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Exploration radioisotopique
Mots-clés Pascal anglais : Angina pectoris, Emission tomography, Exercise tolerance test, Cost efficiency analysis, Health economy, Diagnosis, Prognosis, Human, Cardiovascular disease, Coronary heart disease, Radionuclide study
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0176105
Code Inist : 002B12A03. Création : 16/11/1999.