James K Min1, Amanda Gilmore2, Erica C Jones3, Daniel S Berman4, Wijnand J Stuijfzand3, Leslee J Shaw5, Ken O'Day2, Ibrahim Danad3. 1. The Department of Medicine and Radiology, Weill Medical College of Cornell University, Dalio Institute of Cardiovascular Imaging, The New York Presbyterian Hospital, New York, NY, United States. Electronic address: jkm2001@med.cornell.edu. 2. Xcenda Corporation, Palm Harbor, FL, United States. 3. The Department of Medicine and Radiology, Weill Medical College of Cornell University, Dalio Institute of Cardiovascular Imaging, The New York Presbyterian Hospital, New York, NY, United States. 4. Emory University School of Medicine, Atlanta, GA, United States. 5. Cedars Sinai Medical Center, Los Angeles, CA, United States.
Abstract
PURPOSE: To determine lifetime cost-effectiveness of diagnostic evaluation strategies for individuals with stable chest pain and suspected coronary artery disease (CAD). METHODS: Exercise treadmill testing (ETT), stress echocardiography (SE), myocardial perfusion scintigraphy (MPS), coronary computed tomographic angiography (CCTA), and invasive coronary angiography (ICA) were assessed alone, or in succession to each other. RESULTS: Initial ETT followed by imaging wherein ETT was equivocal or unable to be performed appeared more cost-effective than any strategy employing initial testing by imaging. CONCLUSION: As pre-test likelihood of CAD varies, different modalities including SE, CCTA, and MPS result in improved costs and enhanced effectiveness.
PURPOSE: To determine lifetime cost-effectiveness of diagnostic evaluation strategies for individuals with stable chest pain and suspected coronary artery disease (CAD). METHODS: Exercise treadmill testing (ETT), stress echocardiography (SE), myocardial perfusion scintigraphy (MPS), coronary computed tomographic angiography (CCTA), and invasive coronary angiography (ICA) were assessed alone, or in succession to each other. RESULTS: Initial ETT followed by imaging wherein ETT was equivocal or unable to be performed appeared more cost-effective than any strategy employing initial testing by imaging. CONCLUSION: As pre-test likelihood of CAD varies, different modalities including SE, CCTA, and MPS result in improved costs and enhanced effectiveness.
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