Stress echocardiography-based strategies are cost effective and negate the risk of radiation exposure compared to alternative imaging strategies, according to an analysis published online May 29 in Cardiovascular Ultrasound.

The researchers noted that the diagnostic costs for cardiovascular disease waste a large amount of healthcare resources. Gigliola Bedetti from the Hospital S. Maria della Scaletta in Imola, Italy, and colleagues aimed to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low-risk chest pain patients.

The researchers evaluated direct and indirect downstream costs of six strategies:

1. Coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT);
2. CA after positive exercise electrocardiography (ex-ECG);
3. CA after positive exercise echocardiography (ex-Echo);
4. CA after positive pharmacologic stress echocardiography (PhSE);
5. CA after positive myocardial exercise stress SPECT with technetium Tc 99m sestamibi (ex-SPECT-Tc); and
6. Direct CA.

Direct coronary angiography fared the worst for positive predictive accuracy (18.7 percent), while CA after a positive pharmacologic stress echo (PhSE) had the best predictive accuracy (98.5 percent). The results for the other strategies were:

• 93.4 percent for ex-Echo
• 89.4 percent for ex-SPECT-Tc
• 87 percent for cTn-T
• 85.1 percent for ex-ECG
• 83.1 percent for cTn-I.

The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to one (as a cost comparator) were:

• 1.5x for ex-Echo
• 3.1x for ex-SPECT-Tc
• 3.5x for ex-ECG
• 3.8x for cTnI
• 3.9x for cTnT
• 56.3x for CA.

Bedetti and colleagues found that the cost per patient correctly identified with cardiovascular disease was:

• $533 for PhSE
• $803 for ex-Echo
• $1,521 for ex-SPECT-Tc ($1,634 including cost of extra risk of cancer)
• $1,890 for ex-ECG
• $2,051 for cTn-I
• $2,086 for cTn-T, and
• $29,673 for CA ($29,999 including cost of extra risk of cancer).