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Updated: Jul 11, 2025
06:16
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
439
Comparing Costs of Noninvasive Cardiac Diagnostic Tests-a Population-Based Study
Idan Roifman1, Anna Chu2, Peter C Austin3
1Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
Summary
Noninvasive cardiac diagnostic tests (NITs) for chest pain reduced downstream costs by 12%. Graded exercise stress testing and stress echocardiography were the most cost-effective NITs, while CCTA and MPI increased costs.
Area of Science:
- Cardiology
- Health Economics
- Diagnostic Imaging
Background:
- Noninvasive cardiac diagnostic tests (NITs) for coronary artery disease are costly and potentially overused.
- Comparing the downstream costs of different NIT strategies is crucial for healthcare planning.
Purpose of the Study:
- To compare the downstream costs of four NIT strategies (graded exercise stress testing [GXT], stress echocardiography, cardiac computed tomography angiography [CCTA], and myocardial perfusion imaging [MPI]) versus no testing in patients evaluated for chest pain.
Main Methods:
- Utilized population-based administrative and clinical data from Ontario, Canada.
- Compared downstream costs among patients receiving GXT, stress echocardiography, CCTA, MPI, or no testing.
- Employed a log-gamma generalized linear model to analyze skewed healthcare cost data, adjusting for covariates.
Main Results:
- Any NIT was associated with a 12% reduction in downstream 1-year mean costs compared to no testing.
- Graded exercise stress testing (GXT) and stress echocardiography were linked to lower downstream costs.
- Myocardial perfusion imaging (MPI) and cardiac computed tomography angiography (CCTA) were associated with higher downstream costs.
Conclusions:
- Noninvasive testing in over 2 million chest pain patients was associated with a 12% decrease in downstream costs.
- GXT and stress echocardiography demonstrated the lowest downstream costs.
- CCTA and MPI resulted in higher downstream costs compared to no testing, informing clinical decisions.
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