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Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

2014; Sociedade Brasileira de Cardiologia (SBC); Linguagem: Inglês

10.5935/abc.20140042

1678-4170

A Ferreira, Hugo Marques, Pedro de Araújo Gonçalves, Nuno Cardim,

Acute Myocardial Infarction Research

Background: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy.Objective: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal.Methods: Seven diagnostic strategies were assessed.The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient.The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%.Results: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease.In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective.In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0.In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy.Conclusions: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%.In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy.In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.(