Cost-effectiveness of new tests to diagnose and treat coronary heart disease.

This article provides a review of the methods applied in defining cost-effectiveness as well as a review of the limited evidence base for defining incremental cost-effectiveness ratio of cardiovascular imaging when compared with an office-based risk assessment using the Framingham risk score. To date, there is a growing body of evidence that suggests that screening may be cost-effective in patients with an intermediate Framingham risk score. However, much of this evidence is derived from decision models or simulations that may not adequately represent the use of imaging evidence as it may be derived from "real world" or randomized trial data. Thus, we await additional evidence from large cohort studies or well-controlled clinical trials to define optimal economic efficiency strategies that may include the use of cardiovascular imaging in the screening of patients at risk for coronary heart disease.