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Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease.

Publication ,  Journal Article
Goehler, A; McMahon, PM; Lumish, HS; Wu, CC; Munshi, V; Gilmore, M; Chung, JH; Ghoshhajra, BB; Mark, D; Truong, QA; Gazelle, GS; Hoffmann, U
Published in: Circulation
August 19, 2014

BACKGROUND: Pulmonary nodules (PNs) are often detected incidentally during coronary computed tomographic (CT) angiography, which is increasingly being used to evaluate patients with chest pain symptoms. However, the efficiency of following up on incidentally detected PN is unknown. METHODS AND RESULTS: We determined demographic and clinical characteristics of stable symptomatic patients referred for coronary CT angiography in whom incidentally detected PNs warranted follow-up. A validated lung cancer simulation model was populated with data from these patients, and clinical and economic consequences of follow-up per Fleischner guidelines versus no follow-up were simulated. Of the 3665 patients referred for coronary CT angiography, 591 (16%) had PNs requiring follow-up. The mean age of patients with PNs was 59±10 years; 66% were male; 67% had ever smoked; and 21% had obstructive coronary artery disease. The projected overall lung cancer incidence was 5.8% in these patients, but the majority died of coronary artery disease (38%) and other causes (57%). Follow-up of PNs was associated with a 4.6% relative reduction in cumulative lung cancer mortality (absolute mortality: follow-up, 4.33% versus non-follow-up, 4.54%), more downstream testing (follow-up, 2.34 CTs per patient versus non-follow-up, 1.01 CTs per patient), and an average increase in quality-adjusted life of 7 days. Costs per quality-adjusted life-year gained were $154 700 to follow up the entire cohort and $129 800 per quality-adjusted life-year when only smokers were included. CONCLUSIONS: Follow-up of PNs incidentally detected in patients undergoing coronary CT angiography for chest pain evaluation is associated with a small reduction in lung cancer mortality. However, significant downstream testing contributes to limited efficiency, as demonstrated by a high cost per quality-adjusted life-year, especially in nonsmokers.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 19, 2014

Volume

130

Issue

8

Start / End Page

668 / 675

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Solitary Pulmonary Nodule
  • Risk Assessment
  • Referral and Consultation
  • Quality-Adjusted Life Years
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Incidental Findings
  • Humans
 

Citation

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Goehler, A., McMahon, P. M., Lumish, H. S., Wu, C. C., Munshi, V., Gilmore, M., … Hoffmann, U. (2014). Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease. Circulation, 130(8), 668–675. https://doi.org/10.1161/CIRCULATIONAHA.113.007306
Goehler, Alexander, Pamela M. McMahon, Heidi S. Lumish, Carol C. Wu, Vidit Munshi, Michael Gilmore, Jonathan H. Chung, et al. “Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease.Circulation 130, no. 8 (August 19, 2014): 668–75. https://doi.org/10.1161/CIRCULATIONAHA.113.007306.
Goehler, Alexander, et al. “Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease.Circulation, vol. 130, no. 8, Aug. 2014, pp. 668–75. Pubmed, doi:10.1161/CIRCULATIONAHA.113.007306.
Goehler A, McMahon PM, Lumish HS, Wu CC, Munshi V, Gilmore M, Chung JH, Ghoshhajra BB, Mark D, Truong QA, Gazelle GS, Hoffmann U. Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease. Circulation. 2014 Aug 19;130(8):668–675.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 19, 2014

Volume

130

Issue

8

Start / End Page

668 / 675

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Solitary Pulmonary Nodule
  • Risk Assessment
  • Referral and Consultation
  • Quality-Adjusted Life Years
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Incidental Findings
  • Humans