Author + information
- Received October 14, 1997
- Revision received September 28, 1998
- Accepted November 5, 1998
- Published online March 1, 1999.
- Leslee J. Shaw, PhD∗,‡‡,*,
- Rory Hachamovitch, MD†,‡‡,
- Daniel S. Berman, MD‡,‡‡,
- Thomas H. Marwick, MD§,‡‡,
- Michael S. Lauer, MD§,‡‡,
- Gary V. Heller, MD∥,‡‡,
- Ami E. Iskandrian, MD†,‡,‡‡,
- Karen L. Kesler, MS¶,‡‡,
- Mark I. Travin, MD#,‡‡,
- Howard C. Lewin, MD‡,‡‡,
- Robert C. Hendel, MD∗∗,‡‡,
- Salvador Borges-Neto, MD¶,‡‡,
- D.Douglas Miller, MD††,‡‡,
- for the Economics of Noninvasive Diagnosis (END) Multicenter Study Group
- ↵*Reprint requests and correspondence: Dr. Leslee J. Shaw, Division of Cardiology, Room 638, 1518 Clifton Road, Rollins School of Public Health, Emory University, Atlanta, Georgia 30303
The study aim was to determine observational differences in costs of care by the coronary disease diagnostic test modality.
A number of diagnostic strategies are available with few data to compare the cost implications of the initial test choice.
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.
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).
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.
☆ This study was supported in part by a grant from Dupont Pharma Radiopharmaceuticals and Syncor International Corporation.
Presented in part at the 45th Annual Scientific Sessions of the American College of Cardiology, March 1996, Orlando, Florida.
- Received October 14, 1997.
- Revision received September 28, 1998.
- Accepted November 5, 1998.
- American College of Cardiology