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

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 (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Annals of Internal Medicine American College of Physicians

Book Volume: 165

Pages Range: 94-102

Journal Issue: 2

DOI: 10.7326/M15-2639

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.

Involved external institutions

Duke University Medical Center US United States (USA) (US) US National Institutes of Health (NIH) US United States (USA) (US)

How to cite

APA:

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

MLA:

Mark, Daniel B., et al. "Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease." Annals of Internal Medicine 165.2 (2016): 94-102.

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