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Role of MDCT coronary angiography in the clinical setting: economic implications

Ruolo dell’angiografia coronarica TCMS nella pratica clinica: implicazioni economiche

  • Cardiac Radiology / Cardioradiologia
  • Published:
La radiologia medica

Abstract

Purpose

This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup.

Material and methods

Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary).

Results

Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol.

Conclusions

The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare il valore incrementale dell’introduzione della angiografia coronarica mediante tomografia computerizzata multistrato (AC-TCMS) nella gestione diagnostica del paziente con sospetta malattia coronarica (CAD) rispetto al tradizionale workup diagnostico in termini di rapporto costo/efficacia.

Materiali e metodi

Sono stati considerati 550 pazienti consecutivi sottoposti ad AC-TCMS tra gennaio 2009 e giugno 2011. Sono stati considerati due percorsi diagnostici per pazienti con dolore toracico atipico e sospetta coronaropatia ostruttiva: il protocollo tradizionale (visita, stress test, coronarografia) e il protocollo attuale, (visita, stress test, AC-TCMS ed eventuale coronarografia). è stato calcolato il costo di ogni protocollo come la somma dei costi delle singole metodiche. Sulla base dei risultati i due percorsi diagnostici sono stati confrontati dal punto di vista del rapporto costo/efficacia. è stato proposto un terzo percorso diagnostico modificato con relativo rapporto costo/efficacia (visita, AC-TCMS, stress test, eventuale coronarografia).

Risultati

Lo stress test nei confronti dell’AC-TCMS ha attenuto valori di accuratezza del 66% con sensibilità e specificità del 21% e 87% e valore predittivo positivo (VPP) e valore predittivo negativo (VPN) di 40% e 70%. Il confronto tra ACC e AC-TCMS ha rilevato una sensibilità e specificità pari a 92% e 89%, un VPP e VPN pari a 89% per un’accuratezza complessiva del 92%. Il protocollo tradizionale è risultato avere costi più elevati rispetto a quello modificato dalla AC-TCMS, 1645 euro contro 322 euro (media), ma dimostra un miglior rapporto costo/ efficacia. Il nuovo protocollo proposto risulta avere costi minori, 261 euro in media, con un miglior rapporto costo/ efficacia, rispetto al protocollo tradizionale.

Conclusioni

Il protocollo diagnostico di un paziente con sospetta CAD ha subito variazioni con l’introduzione dell’AC-TCMS. Il nostro studio conferma una maggior performance diagnostica dell’AC-TCMS nei confronti del test da sforzo ed un’accuratezza simile a quella della coronarografia. Dai nostri dati, l’utilizzazione di un protocollo che prevede l’AC-TCMS come spartiacque principale per i pazienti da inviare alla coronarografia, risulta vantaggioso in termini di costo e di efficacia diagnostica.

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Authors and Affiliations

  1. Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy

    Roberto Malagò, Andrea Pezzato, Camilla Barbiani & Roberto Pozzi Mucelli

  2. U.O. Cardiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy

    Domenico Tavella

  3. U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy

    Paola Vallerio, Anna Fratta Pasini & Luciano Cominacini

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  1. Roberto Malagò
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  2. Andrea Pezzato
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  3. Camilla Barbiani
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  8. Roberto Pozzi Mucelli
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Correspondence to Roberto Malagò.

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Malagò, R., Pezzato, A., Barbiani, C. et al. Role of MDCT coronary angiography in the clinical setting: economic implications. Radiol med 118, 1294–1308 (2013). https://doi.org/10.1007/s11547-013-0933-z

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  • DOI: https://doi.org/10.1007/s11547-013-0933-z

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