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Cost-effectiveness of diagnostic strategies for patients with chest pain

K M Kuntz1, K E Fleischmann, M G Hunink

  • 1Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA. kmk@hsph.harvard.edu

Annals of Internal Medicine
|June 5, 1999
PubMed

Insights

For patients with chest pain, exercise electrocardiography or echocardiography offer cost-effective strategies. Routine coronary angiography is best reserved for high-risk individuals, improving quality-adjusted life expectancy.

Area of Science:

  • Cardiology
  • Health Economics
  • Diagnostic Strategies

Background:

  • Noninvasive tests are available for guiding coronary angiography decisions.
  • Routine coronary angiography without prior noninvasive testing is generally not recommended.

Purpose of the Study:

  • To evaluate the cost-effectiveness of various diagnostic strategies for patients presenting with chest pain.

Main Methods:

  • A cost-effectiveness analysis was performed using published data.
  • The study population included patients with chest pain, no history of myocardial infarction, and ability to perform exercise stress tests.
  • Interventions compared were no testing, exercise electrocardiography, exercise echocardiography, exercise SPECT, and coronary angiography alone, over a lifetime horizon.

Main Results:

  • For 55-year-old men with typical angina, exercise echocardiography yielded an incremental cost-effectiveness ratio (ICER) of $36,400 per quality-adjusted life-year (QALY) compared to routine angiography.
  • For atypical angina, exercise echocardiography's ICER was $41,900 per QALY versus exercise ECG.
  • Exercise electrocardiography was cost-effective for nonspecific chest pain ($57,700 per QALY vs. no testing).

Conclusions:

  • Exercise electrocardiography and exercise echocardiography present reasonable cost-effectiveness for mild to moderate risk patients.
  • Coronary angiography without prior noninvasive testing is cost-effective for patients with a high pretest probability of coronary artery disease.
Abstract

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