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Cost-effectiveness of coronary computed tomography and cardiac stress imaging in the emergency department
Citation
Priest, VL and Scuffham, PA and Hachamovitch, R and Marwick, TH, Cost-effectiveness of coronary computed tomography and cardiac stress imaging in the emergency department, JACC: Cardiovascular Imaging, 4, (5) pp. 549-556. ISSN 1936-878X (2011) [Refereed Article]
Copyright Statement
Copyright 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
DOI: doi:10.1016/j.jcmg.2011.03.008
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.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Keywords: | chest pain, coronary computed tomographic angiography, cost-effectiveness, echocardiography, single-photon emission computed tomography, stress electrocardiography |
| Research Division: | Medical and Health Sciences |
| Research Group: | Cardiorespiratory Medicine and Haematology |
| Research Field: | Cardiology (incl. Cardiovascular Diseases) |
| Objective Division: | Health |
| Objective Group: | Clinical Health (Organs, Diseases and Abnormal Conditions) |
| Objective Field: | Cardiovascular System and Diseases |
| Author: | Marwick, TH (Professor Tom Marwick) |
| ID Code: | 90935 |
| Year Published: | 2011 |
| Web of Science® Times Cited: | 28 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2014-05-02 |
| Last Modified: | 2014-06-05 |
| Downloads: | 0 |
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