Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain

Leslee J. Shaw, Thomas H. Marwick, Daniel S. Berman, Stephen Sawada, Gary V. Heller, Charles Vasey, D. Douglas Miller

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Aims: Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. Methods and results: We examined prognosis and cost-effectiveness of exercise echocardiography (n = 4884) vs. SPECT (n = 4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio <$50 000 per life year saved (LYS) was considered favourable for economic efficiency. The risk-adjusted 3-year death or MI rates classified by extent of ischaemia were similar, ranging from 2.3 to 8.0% for echocardiography and from 3.5 to 11.0% for SPECT (model χ2 = 216; P < 0.0001; interaction P = 0.24). Cost-effectiveness ratios for echocardiography were <$20 000/LYS when the annual risk of death or MI was <2%. However, when yearly cardiac event rate were >2%, cost-effectiveness ratios for echocardiography vs. SPECT were in the range of $66 686-$419 522/LYS. For patients with established coronary disease (i.e. ≥2% annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of $32 381/LYS. Conclusion: Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.

Original languageEnglish
Pages (from-to)2448-2458
Number of pages11
JournalEuropean Heart Journal
Volume27
Issue number20
DOIs
StatePublished - Oct 2006

Fingerprint

Single-Photon Emission-Computed Tomography
Chest Pain
Cost-Benefit Analysis
Echocardiography
Exercise
Costs and Cost Analysis
Coronary Disease
Ischemia
Economic Inflation
Health Policy
Proportional Hazards Models
Health Care Costs
Blood Vessels
Referral and Consultation
Perfusion
Myocardial Infarction
Economics
Delivery of Health Care

Keywords

  • Cost effectiveness
  • Echocardiography
  • Prognosis
  • SPECT
  • Stable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain. / Shaw, Leslee J.; Marwick, Thomas H.; Berman, Daniel S.; Sawada, Stephen; Heller, Gary V.; Vasey, Charles; Miller, D. Douglas.

In: European Heart Journal, Vol. 27, No. 20, 10.2006, p. 2448-2458.

Research output: Contribution to journalArticle

Shaw, Leslee J. ; Marwick, Thomas H. ; Berman, Daniel S. ; Sawada, Stephen ; Heller, Gary V. ; Vasey, Charles ; Miller, D. Douglas. / Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain. In: European Heart Journal. 2006 ; Vol. 27, No. 20. pp. 2448-2458.
@article{a3d1ccad44984c9f99aea8cf557c1645,
title = "Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain",
abstract = "Aims: Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. Methods and results: We examined prognosis and cost-effectiveness of exercise echocardiography (n = 4884) vs. SPECT (n = 4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio <$50 000 per life year saved (LYS) was considered favourable for economic efficiency. The risk-adjusted 3-year death or MI rates classified by extent of ischaemia were similar, ranging from 2.3 to 8.0{\%} for echocardiography and from 3.5 to 11.0{\%} for SPECT (model χ2 = 216; P < 0.0001; interaction P = 0.24). Cost-effectiveness ratios for echocardiography were <$20 000/LYS when the annual risk of death or MI was <2{\%}. However, when yearly cardiac event rate were >2{\%}, cost-effectiveness ratios for echocardiography vs. SPECT were in the range of $66 686-$419 522/LYS. For patients with established coronary disease (i.e. ≥2{\%} annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of $32 381/LYS. Conclusion: Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.",
keywords = "Cost effectiveness, Echocardiography, Prognosis, SPECT, Stable angina",
author = "Shaw, {Leslee J.} and Marwick, {Thomas H.} and Berman, {Daniel S.} and Stephen Sawada and Heller, {Gary V.} and Charles Vasey and Miller, {D. Douglas}",
year = "2006",
month = "10",
doi = "10.1093/eurheartj/ehl204",
language = "English",
volume = "27",
pages = "2448--2458",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "20",

}

TY - JOUR

T1 - Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain

AU - Shaw, Leslee J.

AU - Marwick, Thomas H.

AU - Berman, Daniel S.

AU - Sawada, Stephen

AU - Heller, Gary V.

AU - Vasey, Charles

AU - Miller, D. Douglas

PY - 2006/10

Y1 - 2006/10

N2 - Aims: Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. Methods and results: We examined prognosis and cost-effectiveness of exercise echocardiography (n = 4884) vs. SPECT (n = 4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio <$50 000 per life year saved (LYS) was considered favourable for economic efficiency. The risk-adjusted 3-year death or MI rates classified by extent of ischaemia were similar, ranging from 2.3 to 8.0% for echocardiography and from 3.5 to 11.0% for SPECT (model χ2 = 216; P < 0.0001; interaction P = 0.24). Cost-effectiveness ratios for echocardiography were <$20 000/LYS when the annual risk of death or MI was <2%. However, when yearly cardiac event rate were >2%, cost-effectiveness ratios for echocardiography vs. SPECT were in the range of $66 686-$419 522/LYS. For patients with established coronary disease (i.e. ≥2% annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of $32 381/LYS. Conclusion: Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.

AB - Aims: Technological advances in cardiac imaging have led to dramatic increases in test utilization and consumption of a growing proportion of cardiovascular healthcare costs. The opportunity costs of strategies favouring exercise echocardiography or SPECT imaging have been incompletely evaluated. Methods and results: We examined prognosis and cost-effectiveness of exercise echocardiography (n = 4884) vs. SPECT (n = 4637) imaging in stable, intermediate risk, chest pain patients. Ischaemia extent was defined as the number of vascular territories with echocardiographic wall motion or SPECT perfusion abnormalities. Cox proportional hazard models were employed to assess time to cardiac death or myocardial infarction (MI). Total cardiovascular costs were summed (discounted and inflation-corrected) throughout follow-up. A cost-effectiveness ratio <$50 000 per life year saved (LYS) was considered favourable for economic efficiency. The risk-adjusted 3-year death or MI rates classified by extent of ischaemia were similar, ranging from 2.3 to 8.0% for echocardiography and from 3.5 to 11.0% for SPECT (model χ2 = 216; P < 0.0001; interaction P = 0.24). Cost-effectiveness ratios for echocardiography were <$20 000/LYS when the annual risk of death or MI was <2%. However, when yearly cardiac event rate were >2%, cost-effectiveness ratios for echocardiography vs. SPECT were in the range of $66 686-$419 522/LYS. For patients with established coronary disease (i.e. ≥2% annual event risk), SPECT ischaemia was associated with earlier and greater utilization of coronary revascularization (P < 0.0001) resulting in an incremental cost-effectiveness ratio of $32 381/LYS. Conclusion: Health care policies aimed at allocating limited resources can be effectively guided by applying clinical and economic outcomes evidence. A strategy aimed at cost-effective testing would support using echocardiography in low-risk patients with suspected coronary disease, whereas those higher risk patients benefit from referral to SPECT imaging.

KW - Cost effectiveness

KW - Echocardiography

KW - Prognosis

KW - SPECT

KW - Stable angina

UR - http://www.scopus.com/inward/record.url?scp=33749496245&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33749496245&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehl204

DO - 10.1093/eurheartj/ehl204

M3 - Article

C2 - 17003046

AN - SCOPUS:33749496245

VL - 27

SP - 2448

EP - 2458

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 20

ER -