Diagnosis of suspected coronary artery disease in women: A cost- effectiveness analysis

Catherine Kim, Yeong S. Kwok, Somnath (Som) Saha, Rita F. Redberg

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost- effectiveness of several strategies for diagnosing CAD in women with chest pain. Methods: We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup. Results: Diagnosis with angiography cost less than $17,000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing. Conclusions: Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost- effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality- adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55- year-old women with probable angina and nonspecific chest pain.

Original languageEnglish (US)
Pages (from-to)1019-1027
Number of pages9
JournalAmerican Heart Journal
Volume137
Issue number6
StatePublished - 1999
Externally publishedYes

Fingerprint

Cost-Benefit Analysis
Coronary Artery Disease
Exercise
Chest Pain
Echocardiography
Angiography
Quality-Adjusted Life Years
Costs and Cost Analysis
Patient Simulation
Cost of Illness
Thallium
Radionuclide Imaging
Electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Diagnosis of suspected coronary artery disease in women : A cost- effectiveness analysis. / Kim, Catherine; Kwok, Yeong S.; Saha, Somnath (Som); Redberg, Rita F.

In: American Heart Journal, Vol. 137, No. 6, 1999, p. 1019-1027.

Research output: Contribution to journalArticle

Kim, Catherine ; Kwok, Yeong S. ; Saha, Somnath (Som) ; Redberg, Rita F. / Diagnosis of suspected coronary artery disease in women : A cost- effectiveness analysis. In: American Heart Journal. 1999 ; Vol. 137, No. 6. pp. 1019-1027.
@article{ec24526da7c245698a6804eb6b245d60,
title = "Diagnosis of suspected coronary artery disease in women: A cost- effectiveness analysis",
abstract = "Background: The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost- effectiveness of several strategies for diagnosing CAD in women with chest pain. Methods: We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup. Results: Diagnosis with angiography cost less than $17,000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing. Conclusions: Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost- effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality- adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55- year-old women with probable angina and nonspecific chest pain.",
author = "Catherine Kim and Kwok, {Yeong S.} and Saha, {Somnath (Som)} and Redberg, {Rita F.}",
year = "1999",
language = "English (US)",
volume = "137",
pages = "1019--1027",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Diagnosis of suspected coronary artery disease in women

T2 - A cost- effectiveness analysis

AU - Kim, Catherine

AU - Kwok, Yeong S.

AU - Saha, Somnath (Som)

AU - Redberg, Rita F.

PY - 1999

Y1 - 1999

N2 - Background: The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost- effectiveness of several strategies for diagnosing CAD in women with chest pain. Methods: We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup. Results: Diagnosis with angiography cost less than $17,000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing. Conclusions: Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost- effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality- adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55- year-old women with probable angina and nonspecific chest pain.

AB - Background: The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost- effectiveness of several strategies for diagnosing CAD in women with chest pain. Methods: We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup. Results: Diagnosis with angiography cost less than $17,000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing. Conclusions: Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost- effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality- adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55- year-old women with probable angina and nonspecific chest pain.

UR - http://www.scopus.com/inward/record.url?scp=0033404166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033404166&partnerID=8YFLogxK

M3 - Article

C2 - 10347326

AN - SCOPUS:0033404166

VL - 137

SP - 1019

EP - 1027

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 6

ER -