Diagnosis of suspected coronary artery disease in women: A cost- effectiveness analysis

Background: The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost- effectiveness of several strategies for diagnosing CAD in women with chest pain. Methods: We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup. Results: Diagnosis with angiography cost less than $17,000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing. Conclusions: Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost- effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality- adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55- year-old women with probable angina and nonspecific chest pain.