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The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group.

Publication ,  Journal Article
Shaw, LJ; Hachamovitch, R; Berman, DS; Marwick, TH; Lauer, MS; Heller, GV; Iskandrian, AE; Kesler, KL; Travin, MI; Lewin, HC; Hendel, RC ...
Published in: J Am Coll Cardiol
March 1999

OBJECTIVES: The study aim was to determine observational differences in costs of care by the coronary disease diagnostic test modality. BACKGROUND: A number of diagnostic strategies are available with few data to compare the cost implications of the initial test choice. METHODS: We prospectively enrolled 11,372 consecutive stable angina patients who were referred for stress myocardial perfusion tomography or cardiac catheterization. Stress imaging patients were matched by their pretest clinical risk of coronary disease to a series of patients referred to cardiac catheterization. Composite 3-year costs of care were compared for two patients management strategies: 1) direct cardiac catheterization (aggressive) and 2) initial stress myocardial perfusion tomography and selective catheterization of high risk patients (conservative). Analysis of variance techniques were used to compare costs, adjusting for treatment propensity and pretest risk. RESULTS: Observational comparisons of aggressive as compared with conservative testing strategies reveal that costs of care were higher for direct cardiac catheterization in all clinical risk subsets (range: $2,878 to $4,579), as compared with stress myocardial perfusion imaging plus selective catheterization (range: $2,387 to $3,010, p < 0.0001). Coronary revascularization rates were higher for low, intermediate and high risk direct catheterization patients as compared with the initial stress perfusion imaging cohort (13% to 50%, p < 0.0001); cardiac death or myocardial infarction rates were similar (p > 0.20). CONCLUSIONS: Observational assessments reveal that stable chest pain patients who undergo a more aggressive diagnostic strategy have higher diagnostic costs and greater rates of intervention and follow-up costs. Cost differences may reflect a diminished necessity for resource consumption for patients with normal test results.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 1999

Volume

33

Issue

3

Start / End Page

661 / 669

Location

United States

Related Subject Headings

  • Tomography, Emission-Computed, Single-Photon
  • Sensitivity and Specificity
  • Registries
  • Prospective Studies
  • Probability
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shaw, L. J., Hachamovitch, R., Berman, D. S., Marwick, T. H., Lauer, M. S., Heller, G. V., … Miller, D. D. (1999). The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol, 33(3), 661–669. https://doi.org/10.1016/s0735-1097(98)00606-8
Shaw, L. J., R. Hachamovitch, D. S. Berman, T. H. Marwick, M. S. Lauer, G. V. Heller, A. E. Iskandrian, et al. “The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group.J Am Coll Cardiol 33, no. 3 (March 1999): 661–69. https://doi.org/10.1016/s0735-1097(98)00606-8.
Shaw LJ, Hachamovitch R, Berman DS, Marwick TH, Lauer MS, Heller GV, Iskandrian AE, Kesler KL, Travin MI, Lewin HC, Hendel RC, Borges-Neto S, Miller DD. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 1999 Mar;33(3):661–669.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 1999

Volume

33

Issue

3

Start / End Page

661 / 669

Location

United States

Related Subject Headings

  • Tomography, Emission-Computed, Single-Photon
  • Sensitivity and Specificity
  • Registries
  • Prospective Studies
  • Probability
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies