Coronary computed tomography versus exercise testing in patients with stable chest pain: Comparative effectiveness and costs

Tessa S.S. Genders, Bart S. Ferket, Admir Dedic, Tjebbe W. Galema, Nico R.A. Mollet, Pim J. De Feyter, Kirsten E. Fleischmann, Koen Nieman, M. G. Myriam Hunink

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: To determine the comparative effectiveness and costs of a CT-strategy and a stress-electrocardiography-based strategy (standard-of-care; SOC-strategy) for diagnosing coronary artery disease (CAD). Methods: A decision analysis was performed based on a well-documented prospective cohort of 471 outpatients with stable chest pain with follow-up combined with best-available evidence from the literature. Outcomes were correct classification of patients as CAD- (no obstructive CAD), CAD+ (obstructive CAD without revascularization) and indication for Revascularization (using a combination reference standard), diagnostic costs, lifetime health care costs, and quality-adjusted life years (QALY). Parameter uncertainty was analyzed using probabilistic sensitivity analysis. Results: For men (and women), diagnostic cost savings were €245 (€252) for the CT-strategy as compared to the SOC-strategy. The CT-strategy classified 82% (88%) of simulated men (women) in the appropriate disease category, whereas 83% (85%) were correctly classified by the SOC-strategy. The long-term cost-effectiveness analysis showed that the SOC-strategy was dominated by the CT-strategy, which was less expensive (- €229 in men, - €444 in women) and more effective (+ 0.002 QALY in men, + 0.005 in women). The CT-strategy was cost-saving (- €231) but also less effective compared to SOC (- 0.003 QALY) in men with a pre-test probability of ≥ 70%. The CT-strategy was cost-effective in 100% of simulations, except for men with a pre-test probability ≥ 70% in which case it was 59%. Conclusions: The results suggest that a CT-based strategy is less expensive and equally effective compared to SOC in all women and in men with a pre-test probability < 70%.

Original languageEnglish
Pages (from-to)1268-1275
Number of pages8
JournalInternational Journal of Cardiology
Volume167
Issue number4
DOIs
StatePublished - 20 Aug 2013
Externally publishedYes

Keywords

  • Chest pain
  • Comparative cost-effectiveness
  • Coronary CT angiography
  • Coronary artery disease
  • Stress electrocardiography

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