Cost-effectiveness of a novel indication of computed tomography of the coronary arteries.
Cost-effectiveness of a novel indication of computed tomography of the coronary arteries.
复制标题
冠状动脉计算机断层扫描新适应症的成本效益。
DOI：
10.1097/hpc.0b013e318246854c
复制
发表时间：
2012
影响因子：
--
通讯作者：
Khare,RahulK
中科院分区：
文献类型：
--
作者：
Powell,EmilieS;Patterson,BrianW;Venkatesh,ArjunK;Khare,RahulK
目的：在表现为低风险胸痛的患者中排除冠状动脉疾病的一个常见策略是观察单元(OU)入院，并使用一系列心脏生物标志物和负荷试验进行心脏风险分层。尽管患病的可能性很低，但负荷试验呈阳性或不确定的患者经常会因心导管手术入院。本研究的目的是评估冠状动脉计算机断层扫描(CTCA)在评估不确定或阳性负荷试验结果的低风险胸痛患者中的成本-效果。方法：我们进行了一项决策分析研究，以比较3种心脏风险分层策略在住院的低心脏风险患者中的健康结果和成本，这些患者后来接受了不确定或异常负荷试验。我们的人群和测试特征是基于从已发表的文献和以前在我们机构进行的回顾队列审查中获得的数据。比较的三种策略是(1)CTCA策略，在CTCA策略中，负荷试验阳性或不确定的患者随后接受CTCA，只有在结果呈阳性时才接受导尿术；(2)标准护理组，所有负荷试验阳性或不确定的患者都接受导尿；(3)不做任何事情的策略，即所有患者在负荷测试后出院，无论结果如何。测量的结果是护理成本和预期寿命。用多变量蒙特卡罗方法进行敏感性分析。结果：在基本情况下，CTCA和护理标准策略均以不作为策略为主。当将护理标准与CTCA战略进行比较时，每增加一年寿命，成本效益比增加3,423,309美元。敏感性分析显示，在每多一年生命的支付意愿低于60万美元的情况下，CTCA是最有可能具有成本效益的策略。结论：在这项计算机模拟分析中，在对低风险胸痛患者的OU心脏风险分层路径进行阳性或不确定负荷试验后，添加CTCA可以显著节省成本，同时每个患者的预期寿命略有下降。在不确定的或阳性的负荷试验结果之后增加CTCA，对于在OU环境下进行传统冠状动脉造影术之前对低风险胸痛患者进行进一步风险分层是一种经济有效的干预措施。
Objective:A common strategy for excluding coronary artery disease among patients presenting with low-risk chest pain is observation unit (OU) admission with serial cardiac biomarkers and stress testing for cardiac risk stratification. Patients with positive-or indeterminate-stress tests are often admitted for cardiac catheterization despite a low likelihood of disease. The aim of this study is to estimate the cost-effectiveness of computed tomography of the coronary arteries (CTCA) in the OU for the evaluation of low-risk chest pain patients with indeterminate-or positive-stress test results.Methods:We conducted a decision analytic study to compare health outcomes and costs between 3 cardiac risk-stratification strategies in a population of patients at low cardiac risk admitted to the OU, who later had indeterminate-or abnormal-stress tests. Our population and test characteristics were based on data obtained both from the published literature and from a retrospective cohort review previously performed at our institution. The 3 strategies compared were (1) A CTCA strategy in which patients with positive-or indeterminate-stress tests subsequently underwent CTCA, and only received catheterization if results were positive,(2) A standard-of-care arm in which all patients with positive-or indeterminate-stress tests were admitted for catheterization, and (3) A do-nothing strategy in which all patients were discharged home after stress testing regardless of outcome. Outcomes measured were cost of care and life expectancy. Sensitivity analysis was performed with a multivariate Monte Carlo methodology.Results:Both the CTCA and standard-of-care strategies dominated the do-nothing strategy in the base case. When comparing the standard-of-care with the CTCA strategy, the incremental cost-effectiveness ratio was $3,423,309 per additional year of life gained. Sensitivity analysis showed that below a willingness to pay of $600,000 per additional year of life, CTCA was the most likely strategy to be cost-effective.Conclusions:In this computer-modeled analysis, the addition of CTCA following positive-or indeterminate-stress tests to an OU cardiac risk-stratification pathway for low-risk chest pain patients achieved significant cost savings with a small decrease in life expectancy per patient. Adding CTCA after indeterminate-or positive-stress test results is a cost-effective intervention for further risk-stratifying low-risk chest pain patients in the OU setting before proceeding to traditional coronary angiography.
影响因子：
3.3
作者：
Amemiya, Shiori;Takao, Hidemasa
通讯作者：
Takao, Hidemasa