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

Leslee J. Shaw, Rory Hachamovitch, Daniel S. Berman, Thomas H. Marwick, Michael S. Lauer, Gary V. Heller, Ami E. Iskandrian, Karen L. Kesler, Mark I. Travin, Howard C. Lewin, Robert C. Hendel, Salvador Borges-Neto, Donald D Miller

Research output: Contribution to journalArticle

306 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)661-669
Number of pages9
JournalJournal of the American College of Cardiology
Volume33
Issue number3
DOIs
StatePublished - Mar 1 1999
Externally publishedYes

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Stable Angina
Ischemia
Economics
Costs and Cost Analysis
Cardiac Catheterization
Catheterization
Coronary Disease
Perfusion
Tomography
Myocardial Perfusion Imaging
Chest Pain
Routine Diagnostic Tests
Health Care Costs
Analysis of Variance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Shaw, Leslee J.; Hachamovitch, Rory; Berman, Daniel S.; Marwick, Thomas H.; Lauer, Michael S.; Heller, Gary V.; Iskandrian, Ami E.; Kesler, Karen L.; Travin, Mark I.; Lewin, Howard C.; Hendel, Robert C.; Borges-Neto, Salvador; Miller, Donald D.

In: Journal of the American College of Cardiology, Vol. 33, No. 3, 01.03.1999, p. 661-669.

Research output: Contribution to journalArticle

Shaw, Leslee J. ; Hachamovitch, Rory ; Berman, Daniel S. ; Marwick, Thomas H. ; Lauer, Michael S. ; Heller, Gary V. ; Iskandrian, Ami E. ; Kesler, Karen L. ; Travin, Mark I. ; Lewin, Howard C. ; Hendel, Robert C. ; Borges-Neto, Salvador ; Miller, Donald D. / 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. In: Journal of the American College of Cardiology. 1999 ; Vol. 33, No. 3. pp. 661-669.
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abstract = "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.",
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T1 - The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients

T2 - An observational assessment of the value of precatheterization ischemia

AU - Shaw, Leslee J.

AU - Hachamovitch, Rory

AU - Berman, Daniel S.

AU - Marwick, Thomas H.

AU - Lauer, Michael S.

AU - Heller, Gary V.

AU - Iskandrian, Ami E.

AU - Kesler, Karen L.

AU - Travin, Mark I.

AU - Lewin, Howard C.

AU - Hendel, Robert C.

AU - Borges-Neto, Salvador

AU - Miller, Donald D

PY - 1999/3/1

Y1 - 1999/3/1

N2 - 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.

AB - 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.

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