Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease

Daniel B. Mark, Jerome J. Federspiel, Patricia A. Cowper, Kevin J. Anstrom, Udo Hoffmann, Manesh R. Patel, Linda Davidson-Ray, Melanie R. Daniels, Lawton S. Cooper, J. David Knight, Kerry L. Lee, Pamela S. Douglas, Robert Bonow, Garnet Anderson, Alain Bertoni, J. Jeffrey Carr, James K. Min, Michael Proschan, John A. Spertus, Connie M. UlrichHussein R. Al-Khalidi, Denise Bonds, Nakela Cook, Rowena J. Dolor, Alan Go, Christopher Fordyce, Tina Harding, Sarah Hayden, Andrzej Kosinski, Mitchell W. Krucoff, Eric Leifer, Beth Martinez, Daniel W. Mudrick, Michael H. Picard, Geoffrey Rubin, Kristen Salvaggio, Ricky M. Schneider, Alexandra Shen, Jean Claude Tardif, Wanda Tate, James E. Udelson, John Vavalle, Eric J. Velazquez, Jyotsna Garg, Megan Huang, Stephanie Wu, Qinghong Yang, Eric Yow, Aijing Zhang, Charles Apgar, Stephan Achenbach, Erin Corsini, Brian B. Ghoshhajra, Michael Lu, Quynh Truong, Debra Kinan, Edward Carlos, Jason Cole, Michael Johnson, Mathew Krista, Michael Ridner, Aiden Abidov, Barbara Barker, Roger Bies, David Jones, Larry Weathers, Timothy Albert, Kevin Ariani, Supratim Banerjee, Matthew Budoff, Donald Chang, Steven Forman, Gary Foster, Joe Hsu, James Jang, Andrew Kahn, Ronald Karlsberg, Mayil Krishnam, Margaret Lee, Norman Lepor, Irving Loh, Mark Lurie, Michael McConnell, Stefan Ruehm, Gabriel Vorobiof, Simeon Abramson, Steven Friedrich, Jamaluddin Moloo, Stephen Treat, Andrew Keller, Clifford Yang, Dean Bramlet, Edward Braun, Jean Foucauld, Akash Ghai, Pablo Guzman, Robert Hendel, Julian Javier, Carsten Schmalfuss, Carlos Sotolongo, Alan Tannenbaum, Barry Weinstock, Kimberly Champney, Stephen Frohwein, Lonnie Jenkins, Devendra Koganti, Sheldon Litwin, Patricia Shapiro, Cyril Leung, David Hinchman, Stanley Clark, Sorin Danciu, Jerome Hines, Amit Patel, Daniel Sullivan, Dinker Trivedi, Mladen Vidovich, Jo Mahenthiran, Saeed Shaikh, Shawn Teague, Craig Clark, Enrico Martin, Gardar Sigurdsson, Steve Bloom, Michael Hagley, William Schmidt, Vincent Sorrell, Michael Turner, Robert Weiss, Steven Hearne, Scott Jerome, Alexander Morss, Rick Ruberg, Khaled Abdul-Nour, Kavitha Chinnaiyan, Tauqir Goraya, John Heath, Mark Meengs, George Nahhas, Majed Nounou, Souheil Saba, Susan Sallach, Wilson Ginete, Gregory Helmer, Mary McLaurin, Patricia Pellikka, Jamie Pelzel, William Carroll, Arthur Martin, Andrew Rivard, Jeffrey Ciaramita, Zafir Hawa, Pamela Woodard, Alexander Jehle, Michael Delcore, Thomas Porter, Eric Van De Graaff, Navin Budhwani, Renee Bullock-Palmer, Andrey Espinoza, John Kostis, Muhammad Mustafa, Brendan Cavanaugh, Randy Cohen, Robert Donnino, Mario Garcia, Dennis Goodman, John Heitner, Mazullah Kamran, Ellis Lader, Michael Marmulstein, Dhananjai Menzies, Robert Morris, Brian Page, Chong Park, Michael Poon, Michael Wilson, Mahmoud Atieh, David Bohle, Michael Dulin, Christian Gring, Joseph Hakas, Dalton McLean, Mark Rorie, Kevin Sharkey, Yassar Almanaseer, William Dirkes, Jonathan Goldberg, Mark Iler, Karen Kutoloski, Mohammed Maaieh, John Mashny, Robert Pelberg, David Richards, Jodi Tinkel, George Chrysant, Roger Des Prez, Gregory Hill, Iftikhar Hussain, Michael Shapiro, Christopher Allen, Zaruhi Babayan, Terry Bauch, Jennifer Berliner, Alfred Bove, Donald Fox, Ron Jacob, Carlos Jamis-Dow, Venkatesh Nadar, Thomas Phiambolis, David Gregg, David Isbell, Steven Johnson, Priya Kumar, Shobha Hiremagalur, David Huneycutt, Elie Korban, Harry Severance, Subhash Banerjee, Gurpreet Baweja, John Erwin, Osvaldo Gigliotti, Muhammad Khan, Ira Lieber, Frank Navetta, John Osborne, Ahmad Slim, Richard Wilks, Anu George, Aaron Hartman, Robert Levitt, Charles Phillips, Michael Salerno, Brian Schietinger, Jack Slowikowski, Vinay Malhotra, L. Douglas Waggoner, William Carter, Joshua Liberman, Timothy Logemann, John Manley, Steve Port, Mary Zasadil, Benjamin Chow, Eric Larose

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

Original languageEnglish (US)
Pages (from-to)94-102
Number of pages9
JournalAnnals of Internal Medicine
Volume165
Issue number2
DOIs
StatePublished - Jul 19 2016

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Coronary Artery Disease
Economics
Costs and Cost Analysis
Chest Pain
Multicenter Studies
Exercise
Medicare
Tiletamine
Fee Schedules
Physicians
Stress Echocardiography
Fees and Charges
Multidetector Computed Tomography
Hospital Costs
Catheterization
Electrocardiography
Outpatients
Computed Tomography Angiography
Databases
Prospective Studies

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Mark, D. B., Federspiel, J. J., Cowper, P. A., Anstrom, K. J., Hoffmann, U., Patel, M. R., ... Larose, E. (2016). Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. Annals of Internal Medicine, 165(2), 94-102. https://doi.org/10.7326/M15-2639

Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. / Mark, Daniel B.; Federspiel, Jerome J.; Cowper, Patricia A.; Anstrom, Kevin J.; Hoffmann, Udo; Patel, Manesh R.; Davidson-Ray, Linda; Daniels, Melanie R.; Cooper, Lawton S.; Knight, J. David; Lee, Kerry L.; Douglas, Pamela S.; Bonow, Robert; Anderson, Garnet; Bertoni, Alain; Carr, J. Jeffrey; Min, James K.; Proschan, Michael; Spertus, John A.; Ulrich, Connie M.; Al-Khalidi, Hussein R.; Bonds, Denise; Cook, Nakela; Dolor, Rowena J.; Go, Alan; Fordyce, Christopher; Harding, Tina; Hayden, Sarah; Kosinski, Andrzej; Krucoff, Mitchell W.; Leifer, Eric; Martinez, Beth; Mudrick, Daniel W.; Picard, Michael H.; Rubin, Geoffrey; Salvaggio, Kristen; Schneider, Ricky M.; Shen, Alexandra; Tardif, Jean Claude; Tate, Wanda; Udelson, James E.; Vavalle, John; Velazquez, Eric J.; Garg, Jyotsna; Huang, Megan; Wu, Stephanie; Yang, Qinghong; Yow, Eric; Zhang, Aijing; Apgar, Charles; Achenbach, Stephan; Corsini, Erin; Ghoshhajra, Brian B.; Lu, Michael; Truong, Quynh; Kinan, Debra; Carlos, Edward; Cole, Jason; Johnson, Michael; Krista, Mathew; Ridner, Michael; Abidov, Aiden; Barker, Barbara; Bies, Roger; Jones, David; Weathers, Larry; Albert, Timothy; Ariani, Kevin; Banerjee, Supratim; Budoff, Matthew; Chang, Donald; Forman, Steven; Foster, Gary; Hsu, Joe; Jang, James; Kahn, Andrew; Karlsberg, Ronald; Krishnam, Mayil; Lee, Margaret; Lepor, Norman; Loh, Irving; Lurie, Mark; McConnell, Michael; Ruehm, Stefan; Vorobiof, Gabriel; Abramson, Simeon; Friedrich, Steven; Moloo, Jamaluddin; Treat, Stephen; Keller, Andrew; Yang, Clifford; Bramlet, Dean; Braun, Edward; Foucauld, Jean; Ghai, Akash; Guzman, Pablo; Hendel, Robert; Javier, Julian; Schmalfuss, Carsten; Sotolongo, Carlos; Tannenbaum, Alan; Weinstock, Barry; Champney, Kimberly; Frohwein, Stephen; Jenkins, Lonnie; Koganti, Devendra; Litwin, Sheldon; Shapiro, Patricia; Leung, Cyril; Hinchman, David; Clark, Stanley; Danciu, Sorin; Hines, Jerome; Patel, Amit; Sullivan, Daniel; Trivedi, Dinker; Vidovich, Mladen; Mahenthiran, Jo; Shaikh, Saeed; Teague, Shawn; Clark, Craig; Martin, Enrico; Sigurdsson, Gardar; Bloom, Steve; Hagley, Michael; Schmidt, William; Sorrell, Vincent; Turner, Michael; Weiss, Robert; Hearne, Steven; Jerome, Scott; Morss, Alexander; Ruberg, Rick; Abdul-Nour, Khaled; Chinnaiyan, Kavitha; Goraya, Tauqir; Heath, John; Meengs, Mark; Nahhas, George; Nounou, Majed; Saba, Souheil; Sallach, Susan; Ginete, Wilson; Helmer, Gregory; McLaurin, Mary; Pellikka, Patricia; Pelzel, Jamie; Carroll, William; Martin, Arthur; Rivard, Andrew; Ciaramita, Jeffrey; Hawa, Zafir; Woodard, Pamela; Jehle, Alexander; Delcore, Michael; Porter, Thomas; Van De Graaff, Eric; Budhwani, Navin; Bullock-Palmer, Renee; Espinoza, Andrey; Kostis, John; Mustafa, Muhammad; Cavanaugh, Brendan; Cohen, Randy; Donnino, Robert; Garcia, Mario; Goodman, Dennis; Heitner, John; Kamran, Mazullah; Lader, Ellis; Marmulstein, Michael; Menzies, Dhananjai; Morris, Robert; Page, Brian; Park, Chong; Poon, Michael; Wilson, Michael; Atieh, Mahmoud; Bohle, David; Dulin, Michael; Gring, Christian; Hakas, Joseph; McLean, Dalton; Rorie, Mark; Sharkey, Kevin; Almanaseer, Yassar; Dirkes, William; Goldberg, Jonathan; Iler, Mark; Kutoloski, Karen; Maaieh, Mohammed; Mashny, John; Pelberg, Robert; Richards, David; Tinkel, Jodi; Chrysant, George; Des Prez, Roger; Hill, Gregory; Hussain, Iftikhar; Shapiro, Michael; Allen, Christopher; Babayan, Zaruhi; Bauch, Terry; Berliner, Jennifer; Bove, Alfred; Fox, Donald; Jacob, Ron; Jamis-Dow, Carlos; Nadar, Venkatesh; Phiambolis, Thomas; Gregg, David; Isbell, David; Johnson, Steven; Kumar, Priya; Hiremagalur, Shobha; Huneycutt, David; Korban, Elie; Severance, Harry; Banerjee, Subhash; Baweja, Gurpreet; Erwin, John; Gigliotti, Osvaldo; Khan, Muhammad; Lieber, Ira; Navetta, Frank; Osborne, John; Slim, Ahmad; Wilks, Richard; George, Anu; Hartman, Aaron; Levitt, Robert; Phillips, Charles; Salerno, Michael; Schietinger, Brian; Slowikowski, Jack; Malhotra, Vinay; Waggoner, L. Douglas; Carter, William; Liberman, Joshua; Logemann, Timothy; Manley, John; Port, Steve; Zasadil, Mary; Chow, Benjamin; Larose, Eric.

In: Annals of Internal Medicine, Vol. 165, No. 2, 19.07.2016, p. 94-102.

Research output: Contribution to journalArticle

Mark, DB, Federspiel, JJ, Cowper, PA, Anstrom, KJ, Hoffmann, U, Patel, MR, Davidson-Ray, L, Daniels, MR, Cooper, LS, Knight, JD, Lee, KL, Douglas, PS, Bonow, R, Anderson, G, Bertoni, A, Carr, JJ, Min, JK, Proschan, M, Spertus, JA, Ulrich, CM, Al-Khalidi, HR, Bonds, D, Cook, N, Dolor, RJ, Go, A, Fordyce, C, Harding, T, Hayden, S, Kosinski, A, Krucoff, MW, Leifer, E, Martinez, B, Mudrick, DW, Picard, MH, Rubin, G, Salvaggio, K, Schneider, RM, Shen, A, Tardif, JC, Tate, W, Udelson, JE, Vavalle, J, Velazquez, EJ, Garg, J, Huang, M, Wu, S, Yang, Q, Yow, E, Zhang, A, Apgar, C, Achenbach, S, Corsini, E, Ghoshhajra, BB, Lu, M, Truong, Q, Kinan, D, Carlos, E, Cole, J, Johnson, M, Krista, M, Ridner, M, Abidov, A, Barker, B, Bies, R, Jones, D, Weathers, L, Albert, T, Ariani, K, Banerjee, S, Budoff, M, Chang, D, Forman, S, Foster, G, Hsu, J, Jang, J, Kahn, A, Karlsberg, R, Krishnam, M, Lee, M, Lepor, N, Loh, I, Lurie, M, McConnell, M, Ruehm, S, Vorobiof, G, Abramson, S, Friedrich, S, Moloo, J, Treat, S, Keller, A, Yang, C, Bramlet, D, Braun, E, Foucauld, J, Ghai, A, Guzman, P, Hendel, R, Javier, J, Schmalfuss, C, Sotolongo, C, Tannenbaum, A, Weinstock, B, Champney, K, Frohwein, S, Jenkins, L, Koganti, D, Litwin, S, Shapiro, P, Leung, C, Hinchman, D, Clark, S, Danciu, S, Hines, J, Patel, A, Sullivan, D, Trivedi, D, Vidovich, M, Mahenthiran, J, Shaikh, S, Teague, S, Clark, C, Martin, E, Sigurdsson, G, Bloom, S, Hagley, M, Schmidt, W, Sorrell, V, Turner, M, Weiss, R, Hearne, S, Jerome, S, Morss, A, Ruberg, R, Abdul-Nour, K, Chinnaiyan, K, Goraya, T, Heath, J, Meengs, M, Nahhas, G, Nounou, M, Saba, S, Sallach, S, Ginete, W, Helmer, G, McLaurin, M, Pellikka, P, Pelzel, J, Carroll, W, Martin, A, Rivard, A, Ciaramita, J, Hawa, Z, Woodard, P, Jehle, A, Delcore, M, Porter, T, Van De Graaff, E, Budhwani, N, Bullock-Palmer, R, Espinoza, A, Kostis, J, Mustafa, M, Cavanaugh, B, Cohen, R, Donnino, R, Garcia, M, Goodman, D, Heitner, J, Kamran, M, Lader, E, Marmulstein, M, Menzies, D, Morris, R, Page, B, Park, C, Poon, M, Wilson, M, Atieh, M, Bohle, D, Dulin, M, Gring, C, Hakas, J, McLean, D, Rorie, M, Sharkey, K, Almanaseer, Y, Dirkes, W, Goldberg, J, Iler, M, Kutoloski, K, Maaieh, M, Mashny, J, Pelberg, R, Richards, D, Tinkel, J, Chrysant, G, Des Prez, R, Hill, G, Hussain, I, Shapiro, M, Allen, C, Babayan, Z, Bauch, T, Berliner, J, Bove, A, Fox, D, Jacob, R, Jamis-Dow, C, Nadar, V, Phiambolis, T, Gregg, D, Isbell, D, Johnson, S, Kumar, P, Hiremagalur, S, Huneycutt, D, Korban, E, Severance, H, Banerjee, S, Baweja, G, Erwin, J, Gigliotti, O, Khan, M, Lieber, I, Navetta, F, Osborne, J, Slim, A, Wilks, R, George, A, Hartman, A, Levitt, R, Phillips, C, Salerno, M, Schietinger, B, Slowikowski, J, Malhotra, V, Waggoner, LD, Carter, W, Liberman, J, Logemann, T, Manley, J, Port, S, Zasadil, M, Chow, B & Larose, E 2016, 'Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease', Annals of Internal Medicine, vol. 165, no. 2, pp. 94-102. https://doi.org/10.7326/M15-2639
Mark DB, Federspiel JJ, Cowper PA, Anstrom KJ, Hoffmann U, Patel MR et al. Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. Annals of Internal Medicine. 2016 Jul 19;165(2):94-102. https://doi.org/10.7326/M15-2639
Mark, Daniel B. ; Federspiel, Jerome J. ; Cowper, Patricia A. ; Anstrom, Kevin J. ; Hoffmann, Udo ; Patel, Manesh R. ; Davidson-Ray, Linda ; Daniels, Melanie R. ; Cooper, Lawton S. ; Knight, J. David ; Lee, Kerry L. ; Douglas, Pamela S. ; Bonow, Robert ; Anderson, Garnet ; Bertoni, Alain ; Carr, J. Jeffrey ; Min, James K. ; Proschan, Michael ; Spertus, John A. ; Ulrich, Connie M. ; Al-Khalidi, Hussein R. ; Bonds, Denise ; Cook, Nakela ; Dolor, Rowena J. ; Go, Alan ; Fordyce, Christopher ; Harding, Tina ; Hayden, Sarah ; Kosinski, Andrzej ; Krucoff, Mitchell W. ; Leifer, Eric ; Martinez, Beth ; Mudrick, Daniel W. ; Picard, Michael H. ; Rubin, Geoffrey ; Salvaggio, Kristen ; Schneider, Ricky M. ; Shen, Alexandra ; Tardif, Jean Claude ; Tate, Wanda ; Udelson, James E. ; Vavalle, John ; Velazquez, Eric J. ; Garg, Jyotsna ; Huang, Megan ; Wu, Stephanie ; Yang, Qinghong ; Yow, Eric ; Zhang, Aijing ; Apgar, Charles ; Achenbach, Stephan ; Corsini, Erin ; Ghoshhajra, Brian B. ; Lu, Michael ; Truong, Quynh ; Kinan, Debra ; Carlos, Edward ; Cole, Jason ; Johnson, Michael ; Krista, Mathew ; Ridner, Michael ; Abidov, Aiden ; Barker, Barbara ; Bies, Roger ; Jones, David ; Weathers, Larry ; Albert, Timothy ; Ariani, Kevin ; Banerjee, Supratim ; Budoff, Matthew ; Chang, Donald ; Forman, Steven ; Foster, Gary ; Hsu, Joe ; Jang, James ; Kahn, Andrew ; Karlsberg, Ronald ; Krishnam, Mayil ; Lee, Margaret ; Lepor, Norman ; Loh, Irving ; Lurie, Mark ; McConnell, Michael ; Ruehm, Stefan ; Vorobiof, Gabriel ; Abramson, Simeon ; Friedrich, Steven ; Moloo, Jamaluddin ; Treat, Stephen ; Keller, Andrew ; Yang, Clifford ; Bramlet, Dean ; Braun, Edward ; Foucauld, Jean ; Ghai, Akash ; Guzman, Pablo ; Hendel, Robert ; Javier, Julian ; Schmalfuss, Carsten ; Sotolongo, Carlos ; Tannenbaum, Alan ; Weinstock, Barry ; Champney, Kimberly ; Frohwein, Stephen ; Jenkins, Lonnie ; Koganti, Devendra ; Litwin, Sheldon ; Shapiro, Patricia ; Leung, Cyril ; Hinchman, David ; Clark, Stanley ; Danciu, Sorin ; Hines, Jerome ; Patel, Amit ; Sullivan, Daniel ; Trivedi, Dinker ; Vidovich, Mladen ; Mahenthiran, Jo ; Shaikh, Saeed ; Teague, Shawn ; Clark, Craig ; Martin, Enrico ; Sigurdsson, Gardar ; Bloom, Steve ; Hagley, Michael ; Schmidt, William ; Sorrell, Vincent ; Turner, Michael ; Weiss, Robert ; Hearne, Steven ; Jerome, Scott ; Morss, Alexander ; Ruberg, Rick ; Abdul-Nour, Khaled ; Chinnaiyan, Kavitha ; Goraya, Tauqir ; Heath, John ; Meengs, Mark ; Nahhas, George ; Nounou, Majed ; Saba, Souheil ; Sallach, Susan ; Ginete, Wilson ; Helmer, Gregory ; McLaurin, Mary ; Pellikka, Patricia ; Pelzel, Jamie ; Carroll, William ; Martin, Arthur ; Rivard, Andrew ; Ciaramita, Jeffrey ; Hawa, Zafir ; Woodard, Pamela ; Jehle, Alexander ; Delcore, Michael ; Porter, Thomas ; Van De Graaff, Eric ; Budhwani, Navin ; Bullock-Palmer, Renee ; Espinoza, Andrey ; Kostis, John ; Mustafa, Muhammad ; Cavanaugh, Brendan ; Cohen, Randy ; Donnino, Robert ; Garcia, Mario ; Goodman, Dennis ; Heitner, John ; Kamran, Mazullah ; Lader, Ellis ; Marmulstein, Michael ; Menzies, Dhananjai ; Morris, Robert ; Page, Brian ; Park, Chong ; Poon, Michael ; Wilson, Michael ; Atieh, Mahmoud ; Bohle, David ; Dulin, Michael ; Gring, Christian ; Hakas, Joseph ; McLean, Dalton ; Rorie, Mark ; Sharkey, Kevin ; Almanaseer, Yassar ; Dirkes, William ; Goldberg, Jonathan ; Iler, Mark ; Kutoloski, Karen ; Maaieh, Mohammed ; Mashny, John ; Pelberg, Robert ; Richards, David ; Tinkel, Jodi ; Chrysant, George ; Des Prez, Roger ; Hill, Gregory ; Hussain, Iftikhar ; Shapiro, Michael ; Allen, Christopher ; Babayan, Zaruhi ; Bauch, Terry ; Berliner, Jennifer ; Bove, Alfred ; Fox, Donald ; Jacob, Ron ; Jamis-Dow, Carlos ; Nadar, Venkatesh ; Phiambolis, Thomas ; Gregg, David ; Isbell, David ; Johnson, Steven ; Kumar, Priya ; Hiremagalur, Shobha ; Huneycutt, David ; Korban, Elie ; Severance, Harry ; Banerjee, Subhash ; Baweja, Gurpreet ; Erwin, John ; Gigliotti, Osvaldo ; Khan, Muhammad ; Lieber, Ira ; Navetta, Frank ; Osborne, John ; Slim, Ahmad ; Wilks, Richard ; George, Anu ; Hartman, Aaron ; Levitt, Robert ; Phillips, Charles ; Salerno, Michael ; Schietinger, Brian ; Slowikowski, Jack ; Malhotra, Vinay ; Waggoner, L. Douglas ; Carter, William ; Liberman, Joshua ; Logemann, Timothy ; Manley, John ; Port, Steve ; Zasadil, Mary ; Chow, Benjamin ; Larose, Eric. / Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. In: Annals of Internal Medicine. 2016 ; Vol. 165, No. 2. pp. 94-102.
@article{319af443dbc94ca79a06b93e2509792d,
title = "Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease",
abstract = "Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3{\%} annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95{\%} CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.",
author = "Mark, {Daniel B.} and Federspiel, {Jerome J.} and Cowper, {Patricia A.} and Anstrom, {Kevin J.} and Udo Hoffmann and Patel, {Manesh R.} and Linda Davidson-Ray and Daniels, {Melanie R.} and Cooper, {Lawton S.} and Knight, {J. David} and Lee, {Kerry L.} and Douglas, {Pamela S.} and Robert Bonow and Garnet Anderson and Alain Bertoni and Carr, {J. Jeffrey} and Min, {James K.} and Michael Proschan and Spertus, {John A.} and Ulrich, {Connie M.} and Al-Khalidi, {Hussein R.} and Denise Bonds and Nakela Cook and Dolor, {Rowena J.} and Alan Go and Christopher Fordyce and Tina Harding and Sarah Hayden and Andrzej Kosinski and Krucoff, {Mitchell W.} and Eric Leifer and Beth Martinez and Mudrick, {Daniel W.} and Picard, {Michael H.} and Geoffrey Rubin and Kristen Salvaggio and Schneider, {Ricky M.} and Alexandra Shen and Tardif, {Jean Claude} and Wanda Tate and Udelson, {James E.} and John Vavalle and Velazquez, {Eric J.} and Jyotsna Garg and Megan Huang and Stephanie Wu and Qinghong Yang and Eric Yow and Aijing Zhang and Charles Apgar and Stephan Achenbach and Erin Corsini and Ghoshhajra, {Brian B.} and Michael Lu and Quynh Truong and Debra Kinan and Edward Carlos and Jason Cole and Michael Johnson and Mathew Krista and Michael Ridner and Aiden Abidov and Barbara Barker and Roger Bies and David Jones and Larry Weathers and Timothy Albert and Kevin Ariani and Supratim Banerjee and Matthew Budoff and Donald Chang and Steven Forman and Gary Foster and Joe Hsu and James Jang and Andrew Kahn and Ronald Karlsberg and Mayil Krishnam and Margaret Lee and Norman Lepor and Irving Loh and Mark Lurie and Michael McConnell and Stefan Ruehm and Gabriel Vorobiof and Simeon Abramson and Steven Friedrich and Jamaluddin Moloo and Stephen Treat and Andrew Keller and Clifford Yang and Dean Bramlet and Edward Braun and Jean Foucauld and Akash Ghai and Pablo Guzman and Robert Hendel and Julian Javier and Carsten Schmalfuss and Carlos Sotolongo and Alan Tannenbaum and Barry Weinstock and Kimberly Champney and Stephen Frohwein and Lonnie Jenkins and Devendra Koganti and Sheldon Litwin and Patricia Shapiro and Cyril Leung and David Hinchman and Stanley Clark and Sorin Danciu and Jerome Hines and Amit Patel and Daniel Sullivan and Dinker Trivedi and Mladen Vidovich and Jo Mahenthiran and Saeed Shaikh and Shawn Teague and Craig Clark and Enrico Martin and Gardar Sigurdsson and Steve Bloom and Michael Hagley and William Schmidt and Vincent Sorrell and Michael Turner and Robert Weiss and Steven Hearne and Scott Jerome and Alexander Morss and Rick Ruberg and Khaled Abdul-Nour and Kavitha Chinnaiyan and Tauqir Goraya and John Heath and Mark Meengs and George Nahhas and Majed Nounou and Souheil Saba and Susan Sallach and Wilson Ginete and Gregory Helmer and Mary McLaurin and Patricia Pellikka and Jamie Pelzel and William Carroll and Arthur Martin and Andrew Rivard and Jeffrey Ciaramita and Zafir Hawa and Pamela Woodard and Alexander Jehle and Michael Delcore and Thomas Porter and {Van De Graaff}, Eric and Navin Budhwani and Renee Bullock-Palmer and Andrey Espinoza and John Kostis and Muhammad Mustafa and Brendan Cavanaugh and Randy Cohen and Robert Donnino and Mario Garcia and Dennis Goodman and John Heitner and Mazullah Kamran and Ellis Lader and Michael Marmulstein and Dhananjai Menzies and Robert Morris and Brian Page and Chong Park and Michael Poon and Michael Wilson and Mahmoud Atieh and David Bohle and Michael Dulin and Christian Gring and Joseph Hakas and Dalton McLean and Mark Rorie and Kevin Sharkey and Yassar Almanaseer and William Dirkes and Jonathan Goldberg and Mark Iler and Karen Kutoloski and Mohammed Maaieh and John Mashny and Robert Pelberg and David Richards and Jodi Tinkel and George Chrysant and {Des Prez}, Roger and Gregory Hill and Iftikhar Hussain and Michael Shapiro and Christopher Allen and Zaruhi Babayan and Terry Bauch and Jennifer Berliner and Alfred Bove and Donald Fox and Ron Jacob and Carlos Jamis-Dow and Venkatesh Nadar and Thomas Phiambolis and David Gregg and David Isbell and Steven Johnson and Priya Kumar and Shobha Hiremagalur and David Huneycutt and Elie Korban and Harry Severance and Subhash Banerjee and Gurpreet Baweja and John Erwin and Osvaldo Gigliotti and Muhammad Khan and Ira Lieber and Frank Navetta and John Osborne and Ahmad Slim and Richard Wilks and Anu George and Aaron Hartman and Robert Levitt and Charles Phillips and Michael Salerno and Brian Schietinger and Jack Slowikowski and Vinay Malhotra and Waggoner, {L. Douglas} and William Carter and Joshua Liberman and Timothy Logemann and John Manley and Steve Port and Mary Zasadil and Benjamin Chow and Eric Larose",
year = "2016",
month = "7",
day = "19",
doi = "10.7326/M15-2639",
language = "English (US)",
volume = "165",
pages = "94--102",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "2",

}

TY - JOUR

T1 - Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease

AU - Mark, Daniel B.

AU - Federspiel, Jerome J.

AU - Cowper, Patricia A.

AU - Anstrom, Kevin J.

AU - Hoffmann, Udo

AU - Patel, Manesh R.

AU - Davidson-Ray, Linda

AU - Daniels, Melanie R.

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AU - Lee, Kerry L.

AU - Douglas, Pamela S.

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AU - Anderson, Garnet

AU - Bertoni, Alain

AU - Carr, J. Jeffrey

AU - Min, James K.

AU - Proschan, Michael

AU - Spertus, John A.

AU - Ulrich, Connie M.

AU - Al-Khalidi, Hussein R.

AU - Bonds, Denise

AU - Cook, Nakela

AU - Dolor, Rowena J.

AU - Go, Alan

AU - Fordyce, Christopher

AU - Harding, Tina

AU - Hayden, Sarah

AU - Kosinski, Andrzej

AU - Krucoff, Mitchell W.

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AU - Martinez, Beth

AU - Mudrick, Daniel W.

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AU - Salvaggio, Kristen

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AU - Shen, Alexandra

AU - Tardif, Jean Claude

AU - Tate, Wanda

AU - Udelson, James E.

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AU - Velazquez, Eric J.

AU - Garg, Jyotsna

AU - Huang, Megan

AU - Wu, Stephanie

AU - Yang, Qinghong

AU - Yow, Eric

AU - Zhang, Aijing

AU - Apgar, Charles

AU - Achenbach, Stephan

AU - Corsini, Erin

AU - Ghoshhajra, Brian B.

AU - Lu, Michael

AU - Truong, Quynh

AU - Kinan, Debra

AU - Carlos, Edward

AU - Cole, Jason

AU - Johnson, Michael

AU - Krista, Mathew

AU - Ridner, Michael

AU - Abidov, Aiden

AU - Barker, Barbara

AU - Bies, Roger

AU - Jones, David

AU - Weathers, Larry

AU - Albert, Timothy

AU - Ariani, Kevin

AU - Banerjee, Supratim

AU - Budoff, Matthew

AU - Chang, Donald

AU - Forman, Steven

AU - Foster, Gary

AU - Hsu, Joe

AU - Jang, James

AU - Kahn, Andrew

AU - Karlsberg, Ronald

AU - Krishnam, Mayil

AU - Lee, Margaret

AU - Lepor, Norman

AU - Loh, Irving

AU - Lurie, Mark

AU - McConnell, Michael

AU - Ruehm, Stefan

AU - Vorobiof, Gabriel

AU - Abramson, Simeon

AU - Friedrich, Steven

AU - Moloo, Jamaluddin

AU - Treat, Stephen

AU - Keller, Andrew

AU - Yang, Clifford

AU - Bramlet, Dean

AU - Braun, Edward

AU - Foucauld, Jean

AU - Ghai, Akash

AU - Guzman, Pablo

AU - Hendel, Robert

AU - Javier, Julian

AU - Schmalfuss, Carsten

AU - Sotolongo, Carlos

AU - Tannenbaum, Alan

AU - Weinstock, Barry

AU - Champney, Kimberly

AU - Frohwein, Stephen

AU - Jenkins, Lonnie

AU - Koganti, Devendra

AU - Litwin, Sheldon

AU - Shapiro, Patricia

AU - Leung, Cyril

AU - Hinchman, David

AU - Clark, Stanley

AU - Danciu, Sorin

AU - Hines, Jerome

AU - Patel, Amit

AU - Sullivan, Daniel

AU - Trivedi, Dinker

AU - Vidovich, Mladen

AU - Mahenthiran, Jo

AU - Shaikh, Saeed

AU - Teague, Shawn

AU - Clark, Craig

AU - Martin, Enrico

AU - Sigurdsson, Gardar

AU - Bloom, Steve

AU - Hagley, Michael

AU - Schmidt, William

AU - Sorrell, Vincent

AU - Turner, Michael

AU - Weiss, Robert

AU - Hearne, Steven

AU - Jerome, Scott

AU - Morss, Alexander

AU - Ruberg, Rick

AU - Abdul-Nour, Khaled

AU - Chinnaiyan, Kavitha

AU - Goraya, Tauqir

AU - Heath, John

AU - Meengs, Mark

AU - Nahhas, George

AU - Nounou, Majed

AU - Saba, Souheil

AU - Sallach, Susan

AU - Ginete, Wilson

AU - Helmer, Gregory

AU - McLaurin, Mary

AU - Pellikka, Patricia

AU - Pelzel, Jamie

AU - Carroll, William

AU - Martin, Arthur

AU - Rivard, Andrew

AU - Ciaramita, Jeffrey

AU - Hawa, Zafir

AU - Woodard, Pamela

AU - Jehle, Alexander

AU - Delcore, Michael

AU - Porter, Thomas

AU - Van De Graaff, Eric

AU - Budhwani, Navin

AU - Bullock-Palmer, Renee

AU - Espinoza, Andrey

AU - Kostis, John

AU - Mustafa, Muhammad

AU - Cavanaugh, Brendan

AU - Cohen, Randy

AU - Donnino, Robert

AU - Garcia, Mario

AU - Goodman, Dennis

AU - Heitner, John

AU - Kamran, Mazullah

AU - Lader, Ellis

AU - Marmulstein, Michael

AU - Menzies, Dhananjai

AU - Morris, Robert

AU - Page, Brian

AU - Park, Chong

AU - Poon, Michael

AU - Wilson, Michael

AU - Atieh, Mahmoud

AU - Bohle, David

AU - Dulin, Michael

AU - Gring, Christian

AU - Hakas, Joseph

AU - McLean, Dalton

AU - Rorie, Mark

AU - Sharkey, Kevin

AU - Almanaseer, Yassar

AU - Dirkes, William

AU - Goldberg, Jonathan

AU - Iler, Mark

AU - Kutoloski, Karen

AU - Maaieh, Mohammed

AU - Mashny, John

AU - Pelberg, Robert

AU - Richards, David

AU - Tinkel, Jodi

AU - Chrysant, George

AU - Des Prez, Roger

AU - Hill, Gregory

AU - Hussain, Iftikhar

AU - Shapiro, Michael

AU - Allen, Christopher

AU - Babayan, Zaruhi

AU - Bauch, Terry

AU - Berliner, Jennifer

AU - Bove, Alfred

AU - Fox, Donald

AU - Jacob, Ron

AU - Jamis-Dow, Carlos

AU - Nadar, Venkatesh

AU - Phiambolis, Thomas

AU - Gregg, David

AU - Isbell, David

AU - Johnson, Steven

AU - Kumar, Priya

AU - Hiremagalur, Shobha

AU - Huneycutt, David

AU - Korban, Elie

AU - Severance, Harry

AU - Banerjee, Subhash

AU - Baweja, Gurpreet

AU - Erwin, John

AU - Gigliotti, Osvaldo

AU - Khan, Muhammad

AU - Lieber, Ira

AU - Navetta, Frank

AU - Osborne, John

AU - Slim, Ahmad

AU - Wilks, Richard

AU - George, Anu

AU - Hartman, Aaron

AU - Levitt, Robert

AU - Phillips, Charles

AU - Salerno, Michael

AU - Schietinger, Brian

AU - Slowikowski, Jack

AU - Malhotra, Vinay

AU - Waggoner, L. Douglas

AU - Carter, William

AU - Liberman, Joshua

AU - Logemann, Timothy

AU - Manley, John

AU - Port, Steve

AU - Zasadil, Mary

AU - Chow, Benjamin

AU - Larose, Eric

PY - 2016/7/19

Y1 - 2016/7/19

N2 - Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

AB - Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

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UR - http://www.scopus.com/inward/citedby.url?scp=84979520669&partnerID=8YFLogxK

U2 - 10.7326/M15-2639

DO - 10.7326/M15-2639

M3 - Article

AN - SCOPUS:84979520669

VL - 165

SP - 94

EP - 102

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 2

ER -