Cost-benefit analysis of electron beam CT as a life insurance coronary disease risk assessment tool

Electron beam CT (EBCT) or ultrafast CT is a diagnostic imaging technique that can identify calcium deposits within coronary arteries. Intra-coronary calcium is associated with coronary artery atherosclerosis. EBCT imaging has been advocated as a "better" way to screen for coronary artery disease. By producing a measure of the amount of calcium present, it may provide a non-invasive risk assessment tool that can predict the risk of future coronary events and death. Medical literature concerning identification and assessment of coronary risk using EBCT in the clinical setting is reviewed. The primary purpose is to illustrate one approach to a simple "back of the envelope" cost-benefit analysis (protective value) comparing EBCT with exercise electrocardiography as a life insurance coronary disease risk assessment tool. The performance and results of this analysis are contingent on a number of critical assumptions that are outlined in the text. The analysis limitations, and the future research required to refine the results are reviewed. With optimum levels of EBCT test performance, favorable thresholds of test costs, and long-term mortality data useful for assessment of value preservation, EBCT might prove to be a valuable risk assessment tool from a cost-benefit perspective under certain circumstances. Answers to key clinical research questions from prospective studies in asymptomatic cohorts are essential for refinement of a cost-benefit estimate.