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Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country

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Journal of Nuclear Cardiology Aims and scope

Abstract

Myocardial perfusion imaging is widely used for the risk stratification of coronary artery disease. In view of its cost, besides radiation issues, judicious evaluation of the appropriateness of its indications is essential to prevent an unnecessary economic burden on the health system. We evaluated, at a tertiary-care, public Brazilian hospital, the appropriateness of myocardial perfusion scintigraphy indications, and estimated the budget impact of applying appropriateness criteria. An observational, cross-sectional study of 190 patients with suspected or known coronary artery disease referred for myocardial perfusion imaging was conducted. The appropriateness of myocardial perfusion imaging indications was evaluated with the Appropriate Use Criteria for Cardiac Radionuclide Imaging published in 2009. Budget impact analysis was performed with a deterministic model. The prevalence of appropriate requests was 78%; of inappropriate indications, 12%; and of uncertain indications, 10%. Budget impact analysis showed that the use of appropriateness criteria, applied to the population referred to myocardial perfusion scintigraphy within 1 year, could generate savings of $ 64,252.04 dollars. The 12% inappropriate requests for myocardial perfusion scintigraphy at a tertiary-care hospital suggest that a reappraisal of MPI indications is needed. Budget impact analysis estimated resource savings of 18.6% with the establishment of appropriateness criteria for MPI.

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Abbreviations

AUC:

Appropriate Use Criteria for Cardiac Radionuclide Imaging

BIA:

Budget impact analysis

CPET:

Cardiopulmonary exercise testing

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CHD:

Coronary heart disease

ECG:

Electrocardiogram

ET:

Exercise test

MPI:

Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

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Authors and Affiliations

  1. Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil

    Mauro Augusto dos Santos MD, MSc, Marisa Silva Santos MD, PhD, Bernardo Rangel Tura MD, PhD, Renata Félix MD, MSc, Adriana Soares X. Brito MD, MSc & Andrea De Lorenzo MD, PhD

Authors
  1. Mauro Augusto dos Santos MD, MSc
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  2. Marisa Silva Santos MD, PhD
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  3. Bernardo Rangel Tura MD, PhD
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  4. Renata Félix MD, MSc
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  5. Adriana Soares X. Brito MD, MSc
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  6. Andrea De Lorenzo MD, PhD
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Correspondence to Andrea De Lorenzo MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-016-0562-8.

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dos Santos, M.A., Santos, M.S., Tura, B.R. et al. Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country. J. Nucl. Cardiol. 23, 1160–1165 (2016). https://doi.org/10.1007/s12350-016-0505-4

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  • DOI: https://doi.org/10.1007/s12350-016-0505-4

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