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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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[Cost-effectiveness of exercise 201Tl myocardial SPECT in patients with chest pain assessed by decision-tree

S Kosuda1, K Ichihara, Y Momiyama

  • 1Department of Study Diagnosis, Kawasaki Medical College.

Kaku Igaku. the Japanese Journal of Nuclear Medicine
|November 5, 1999
PubMed

Insights

Exercise 201Tl myocardial SPECT is a cost-effective strategy for diagnosing angina-like chest pain. This diagnostic approach reduces healthcare costs in Japan by minimizing invasive coronary arteriography procedures.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Health Economics

Background:

  • Angina-like chest pain is a common presenting symptom in outpatients.
  • Accurate and cost-effective diagnosis is crucial for managing patients with suspected coronary artery disease.
  • Coronary arteriography (CAG) is invasive, while exercise 201Tl myocardial SPECT offers a non-invasive alternative.

Purpose of the Study:

  • To evaluate the cost-effectiveness of exercise 201Tl myocardial SPECT compared to CAG and follow-up strategies.
  • To assess the impact of SPECT on healthcare costs and cardiac events in patients with chest pain.

Main Methods:

  • A decision-tree model was developed analyzing three 1000-patient groups: CAG, follow-up, and SPECT.
  • Data on costs, cardiac events, and deaths were collected from references and hospital data.
  • Assumed sensitivity (95%) and specificity (85%) for 201Tl SPECT in diagnosing angina pectoris.

Main Results:

  • Exercise 201Tl myocardial SPECT strategy cost 71.0 x 10^4 yen/patient, compared to 84.9 x 10^4 yen/patient for CAG.
  • SPECT resulted in slightly increased cardiac events (0.9%) and deaths (0.2%) but reduced CAG studies by 50.3%.
  • The SPECT strategy saved 13.8 x 10^4 yen/patient compared to the CAG group.

Conclusions:

  • Exercise 201Tl myocardial SPECT is a potentially cost-effective diagnostic strategy for outpatients with angina-like chest pain in Japan.
  • This approach can significantly reduce the need for invasive CAG procedures.
  • Implementing SPECT can lead to substantial healthcare cost savings.

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