Background The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined.
We compared the cost-effectiveness of several strategies for diagnosing CAD in women with chest pain.
Methods We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain.
With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup.
Results Diagnosis with angiography cost less than $17,000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina.
If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing.
Conclusions Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD.
Diagnosis of coronary artery disease with angiography is cost-effective in 55-year-old women with definite angina.
In 55-year-old women with probable angina, diagnosis with angiography would increase quality-adjusted life-years but significantly increase costs.
Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55-year-old women with probable angina and nonspecific chest pain.
Mots-clés Pascal : Cardiopathie coronaire, Analyse coût efficacité, Economie santé, Electrocardiographie, Epreuve effort, Scintigraphie, Angiographie, Etude longitudinale, Diagnostic, Homme, Appareil circulatoire pathologie, Electrodiagnostic, Exploration radioisotopique, Imagerie médicale, Radiodiagnostic
Mots-clés Pascal anglais : Coronary heart disease, Cost efficiency analysis, Health economy, Electrocardiography, Exercise tolerance test, Scintigraphy, Angiography, Follow up study, Diagnosis, Human, Cardiovascular disease, Electrodiagnosis, Radionuclide study, Medical imagery, Radiodiagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0329796
Code Inist : 002B12A03. Création : 16/11/1999.