Comparison of Cost-Effectiveness and Utility of Exercise ECG, Single Photon Emission Computed Tomography, Positron Emission Tomography, and Coronary Angiography for Diagnosis of Coronary Artery Disease

作者：Randolph E. Patterson, Robert L. Eisner, Steven F. Horowitz · 发表于：Circulation · 年份：1995 · DOI：10.1161/01.cir.91.1.54 · 被引用次数：199 · 研究领域：Cardiac Imaging and Diagnostics、Coronary Interventions and Diagnostics、Acute Myocardial Infarction Research

BACKGROUND: To compare cost-effectiveness and utility of four clinical algorithms to diagnose obstructive coronary atherosclerotic heart disease (CAD), we compared exercise ECG (ExECG), stress single photon emission computed tomography (SPECT), positron emission tomography (PET), and coronary angiography. METHODS AND RESULTS: Published data and a straightforward mathematical model based on Bayes' theorem were used to compare strategies. Effectiveness was defined as the number of patients with diagnosed CAD, and utility was defined as the clinical outcome, ie, the number of quality-adjusted life years (QALY) extended by therapy after the diagnosis of CAD. Our model used published values for costs, accuracy, and complication rates of tests. Analysis of the model indicates the following results. (1) The direct cost (fee) for each test differs considerably from total cost per delta QALY. (2) As pretest likelihood of CAD (pCAD) in the population increases, there is a linear increase in cost per patient tested but a hyperbolic decrease in cost per effect and cost per utility unit, ie, increased cost-effectiveness and decreased cost per utility unit. (3) At pCAD < 0.70, analysis of the model indicates that stress PET is the most cost-effective test, with the lowest cost per utility, followed by SPECT, ExECG, and angiography, in that order. (4) Above a threshold value of pCAD of 0.70 (for example, middle-aged men with typical angina), proceeding directly to angiography as the first t...