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Diagnosis of suspected coronary artery disease in women: a cost-effectiveness analysis
1Department of Medicine and the Division of Cardiology, University of California, San Francisco, CA 94131-0214, USA.
Insights
For women with chest pain, the most cost-effective strategy for diagnosing coronary artery disease (CAD) depends on symptom severity. Angiography is best for definite angina, while exercise echocardiography is suitable for probable or nonspecific chest pain.
Area of Science:
- Cardiology
- Health Economics
- Diagnostic Strategy
Background:
- Optimal diagnosis strategy for coronary artery disease (CAD) in women remains undefined.
- Comparison of cost-effectiveness for various CAD diagnostic approaches in women presenting with chest pain.
Purpose of the Study:
- To evaluate and compare the cost-effectiveness of different diagnostic strategies for coronary artery disease (CAD) in women experiencing chest pain.
Main Methods:
- Decision and cost-effectiveness analyses were conducted using Markov models.
- Simulations involved 55-year-old women with chest pain undergoing strategies including exercise electrocardiography, thallium scintigraphy, exercise echocardiography, angiography, or no diagnostic workup.
Main Results:
- Angiography was cost-effective for definite angina (<$17,000/QALY) and probable angina (<$76,000/LY).
- Exercise echocardiography increased life-years for nonspecific chest pain compared to no testing.
Conclusions:
- The cost-effectiveness of first-line CAD diagnostic strategies in women is contingent on the pretest probability of disease.
- Angiography is cost-effective for definite angina; exercise echocardiography is cost-effective for probable or nonspecific chest pain in 55-year-old women.
Background:
The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost-effectiveness of several strategies for diagnosing CAD in women with chest pain.
Methods:
We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup.
Results:
Diagnosis with angiography cost less than $17, 000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing.
Conclusions:
Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost-effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality-adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55-year-old women with probable angina and nonspecific chest pain.