Abstract
Objective
To conduct an economic analysis (EA) of coronary calcium scoring (CCS) using a 0 score, as alternative to stress electrocardiography (sECG) in diagnosing coronary artery disease (CAD).
Method
A decision tree was constructed to compare four strategies for investigation of suspected CAD previously assessed in the formulation of clinical guidelines for the United Kingdom (UK) to two new strategies incorporating CCS. Sensitivity (96%; 95% CI 95.4–96.4%) and specificity (40%; 95% CI 38.7–41.4%) values for CCS were derived from a meta-analysis of 10,760 patients. Other input variables were obtained from a previous EA and average prices for hospital procedures in the UK. A threshold of £30,000/Quality-adjusted Life Year (QALY) was considered cost-effective.
Results
Using net monetary benefit calculations, CCS-based strategies were found to be cost-effective compared to sECG equivalents at all assessed prevalence of CAD. Using CCS prior to myocardial perfusion scintigraphy (MPS) and catheter angiography (CA) was found to be cost-effective at pre-test probabilities (PTP) below 30%.
Conclusions
Adoption of CCS as an alternative to sECG in investigating suspected stable angina in low PTP population (<30%) would be cost-effective. In patients with PTP of CAD >30%, proceeding to MPS or CA would be more cost-effective than performing either CCS or sECG.
Key Points
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Coronary calcium scoring (CCS) is useful for assessing coronary artery atherosclerosis
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It can be performed with multi-detector CT, which is now widely available
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It plays a role in excluding disease in suspected stable angina
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Our study assesses its role in this setting as alternative to stress-ECG
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Adoption of CCS as an alternative to sECG could prove cost-effective
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Acknowledgements
Authors performed statistical analysis in this study. In particular we wish to thank Dr A. Parfienczyk and the staff at the Clinical Imaging Sciences Centre, Falmer Campus, Brighton and Sussex Medical School.
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Raman, V., McWilliams, E.T.M., Holmberg, S.R.M. et al. Economic analysis of the use of coronary calcium scoring as an alternative to stress ECG in the non-invasive diagnosis of coronary artery disease. Eur Radiol 22, 579–587 (2012). https://doi.org/10.1007/s00330-011-2304-2
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DOI: https://doi.org/10.1007/s00330-011-2304-2