Stress Echo Less Expensive and Decreases Risks for Patients with Chest Pain
A study published in Cardiovascular Ultrasound proposed use of stress echocardiography-based imaging approaches (pdf) to assess patients who present with chest pain. The team, based in Imola, Italy, evaluated economic and clinical outcomes of this imaging modality compared to other approaches utilized.
One factor encouraging completion of this effort was the high cost associated with diagnosis of cardiovascular conditions. The group considered the direct and indirect longterm costs of six different diagnostic approaches:
- Coronary angiography (CA) after positive troponin (cTn-1 or cTnT),
- CA after positive exercise electrocardiography (ex-ECG),
- CA after positive exercise echocardiography (Ex-Echo),
- CA after positive pharmacologic stress echocardiography (PhSE),
- CA after positive myocardial exercise stress SPECT with technetium Tc 99m sestambi, and
- Direct CA.
The team assessed the predictive accuracy of each modality. The imaging type with the highest level of accuracy was pharmacologic stress echo at 98.5 percent, followed by ex-SPECT-tc was 89.4 percent. The study with the lowest accuracy was direct coronary angiography, at 18.7 percent.
Cost-effectiveness for each modality were also assessed. The most expensive was direct CA. The least expensive was stress echo followed by exercise echocardiography.
The other cost computed was the amount for each patient correctly assessed. The lowest cost was stress echo, followed by exercise echo, then exercise SPECT. The additional benefit of this approach is that it decreases the amount of radiation to which patients are exposed.
June 9, 2008 Related topics: Diagnostic, Cardiology