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Ann Intern Med. 2016 Jul 19;165(2):94-102. doi: 10.7326/M15-2639. Epub 2016 May 24.

Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.

Abstract

BACKGROUND:

PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing.

OBJECTIVE:

To conduct an economic analysis for PROMISE (a major secondary aim of the study).

DESIGN:

Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550).

SETTING:

190 U.S. centers.

PATIENTS:

9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months.

MEASUREMENTS:

Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods.

RESULTS:

The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, -$634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small.

LIMITATION:

Cost weights for test strategies were obtained from sources outside PROMISE.

CONCLUSION:

Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

PRIMARY FUNDING SOURCE:

National Heart, Lung, and Blood Institute.

PMID:
27214597
PMCID:
PMC5046832
DOI:
10.7326/M15-2639
[Indexed for MEDLINE]
Free PMC Article

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