Research

Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

Gigliola Bedetti¹ , Emilio Maria Pasanisi² , Carmine Pizzi³ , Giuseppe Turchetti⁴ and Cosimo Loré⁵

¹  Hospital S. Maria della Scaletta, Imola, Italy

²  CNR, Institute of Clinical Physiology, Pisa, Italy

³  Cardiology dept., University of Bologna, Italy

⁴  Scuola Superiore Sant'Anna, Pisa, Italy

⁵  Institute of Legal Medicine, University of Siena, Italy

author email corresponding author email

Cardiovascular Ultrasound 2008, 6:21doi:10.1186/1476-7120-6-21

Published:	29 May 2008

Abstract

Background

Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients.

Methods

We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6).

Results

The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×.

Conclusion

Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void.