Effects on costs of frontline diagnostic evaluation in patients suspected of angina: coronary computed tomography angiography vs. conventional ischaemia testing

Lene H Nielsen; Jens Olsen; John Markenvard; Jesper Møller Jensen; Bjarne Linde Nørgaard

doi:10.1093/ehjci/jes166

Effects on costs of frontline diagnostic evaluation in patients suspected of angina

Authors:

Nielsen, Lene H ;
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unknown
Olsen, Jens ;
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The Study Committee for Law, Faculty of Social Sciences, Aarhus University, Aarhus University
Markenvard, John ;
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Department of Clinical Medicine - Medicinsk afd., Fredericia, Department of Clinical Medicine, Health, Aarhus University
Jensen, Jesper Møller ;
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Department of Clinical Medicine - The Department of Cardiological Medicine B, Department of Clinical Medicine, Health, Aarhus University
Nørgaard, Bjarne Linde
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The Department of Cardiological Medicine B, Faculty of Health Sciences, Aarhus University, Aarhus University

Subtitle:

coronary computed tomography angiography vs. conventional ischaemia testing

DOI:

10.1093/ehjci/jes166

Abstract:

AIMS: The aim of this study was to investigate in patients with stable angina the effects on costs of frontline diagnostics by exercise-stress testing (ex-test) vs. coronary computed tomography angiography (CTA). METHODS AND RESULTS: In two coronary units at Lillebaelt Hospital, Denmark, 498 patients were identified in whom either ex-test (n = 247) or CTA (n = 251) were applied as the frontline diagnostic strategy in symptomatic patients with a low-intermediate pre-test probability of coronary artery disease (CAD). During 12 months of follow-up, death, myocardial infarction and costs associated with downstream diagnostic utilization (DTU), treatment, ambulatory visits, and hospitalizations were registered. There was no difference between cohorts in demographic characteristics or the pre-test probability of significant CAD. The mean (SD) age was 56 (11) years; 52% were men; and 96% were at low-intermediate pre-test probability of CAD. All serious cardiac events (n = 3) during follow-up occurred in patients with a negative ex-test result. Mean costs per patient associated with DTU, ambulatory visits, and cardiovascular medication were significantly higher in the ex-test than in the CTA group. The mean (SD) total costs per patient at the end of thefollow-up were 14% lower in the CTA group than in the ex-test group, € 1510 (3474) vs. €1777 (3746) (P = 0.03). CONCLUSION: Diagnostic assessment of symptomatic patients with a low-intermediate probability of CAD by CTA incurred lower costs when compared with the ex-test. These findings need confirmation in future prospective trials.

Type:

Journal article

Language:

English

Published in:

International Journal of Cardiovascular Imaging, 2012, Vol 27, Issue 5, p. 813-823

Main Research Area:

Medical science

Publication Status:

Published

Review type:

Peer Review

Submission year:

2012

Scientific Level:

Scientific

ID:

240699483

Effects on costs of frontline diagnostic evaluation in patients suspected of angina

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