Economic Outcomes in the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease Registry
Economic Outcomes in the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease Registry
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DOI：
10.1016/j.jacc.2013.11.038
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发表时间：
2014-03-18
影响因子：
24
通讯作者：
DiCarli, Marcelo F.
中科院分区：
文献类型：
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作者：
Hlatky, Mark A.;Shilane, David;DiCarli, Marcelo F.
目的本研究的目的是比较患者接受不同的非侵入性检查，以评估可疑的冠状动脉疾病（CAD）的经济后果。背景评价的非侵入性测试正在转向评估其对临床结果的影响，而不是对他们的诊断准确性。在不断上升的医疗保健成本中，检测的经济结果尤为重要。方法我们使用了一项观察性登记研究，共有1,703例患者接受了冠状动脉计算机断层扫描血管造影术（CTA）（n = 590），正电子发射断层扫描（PET）（n = 548），或单光子发射计算机断层扫描（SPECT）（n = 565），用于在41个中心中的1个中心诊断疑似CAD。我们对患者进行了2年的随访，并记录了资源使用、CAD的医疗费用和临床结局。我们使用多变量分析和倾向评分匹配来控制基线特征的差异。（6，647美元，95%置信区间[CI]：5，896美元至7，397美元），CTA后中等（4，909美元，95% CI：4，378至5，440美元），SPECT后最低（3，965美元，95% CI：3，520至4，411美元）。多变量校正后，CTA成本比SPECT高15%（p < 0.01），PET成本比SPECT高22%（p < 0.0001）。CTA、SPECT和PET后的两年死亡率分别为0.7%、1.6%和5.5%。与SPECT相比，CTA的增量成本效益比为每生命年增加11，700美元，但不确定，在13%的自助复制中成本更高，死亡率更高。接受PET的患者有更高的成本和更高的死亡率比接受SPECT的患者在98%的bootstrap replication.Conclusions成本显着降低后，使用SPECT，而不是CTA或PET在可疑的冠状动脉疾病的评估。与PET相比，SPECT在经济上具有吸引力，而CTA与SPECT相比成本更高，死亡率无显著差异。(C)2014年美国心脏病学会基金会
Objectives The goal of this study was to compare the economic outcomes of patients undergoing different noninvasive tests to evaluate suspected coronary artery disease (CAD).Background Evaluation of noninvasive tests is shifting to an assessment of their effect on clinical outcomes rather than on their diagnostic accuracy. Economic outcomes of testing are particularly important in light of rising medical care costs.Methods We used an observational registry of 1,703 patients who underwent coronary computed tomography angiography (CTA) (n = 590), positron emission tomography (PET) (n = 548), or single-photon emission computed tomography (SPECT) (n = 565) for diagnosis of suspected CAD at 1 of 41 centers. We followed patients for 2 years, and documented resource use, medical costs for CAD, and clinical outcomes. We used multivariable analysis and propensity score matching to control for differences in baseline characteristics.Results Two-year costs were highest after PET ($6,647, 95% confidence interval [CI]: $5,896 to $7,397), intermediate after CTA ($4,909, 95% CI: $4,378 to $5,440), and lowest after SPECT ($3,965, 95% CI: $3,520 to $4,411). After multivariable adjustment, CTA costs were 15% higher than SPECT (p < 0.01), and PET costs were 22% higher than SPECT (p < 0.0001). Two-year mortality was 0.7% after CTA, 1.6% after SPECT, and 5.5% after PET. The incremental cost-effectiveness ratio for CTA compared with SPECT was $11,700 per life-year added, but was uncertain, with higher costs and higher mortality in 13% of bootstrap replications. Patients undergoing PET had higher costs and higher mortality than patients undergoing SPECT in 98% of bootstrap replications.Conclusions Costs were significantly lower after using SPECT rather than CTA or PET in the evaluation of suspected coronary disease. SPECT was economically attractive compared with PET, whereas CTA was associated with higher costs and no significant difference in mortality compared with SPECT. (C) 2014 by the American College of Cardiology Foundation