Stress echocardiography-based strategies are cheaper, less risky
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 diagnosis 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 with the study.

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. After positive exercise electrocardiography (ex-ECG);
3. After positive exercise echocardiography (ex-Echo);
4. After positive pharmacologic stress echocardiography (PhSE);
5. After positive myocardial exercise stress SPECT with technetium Tc 99m sestamibi (ex-SPECT-Tc); and
6. Direct CA.
The investigators found that the predictive accuracy in correctly identifying the patients was 83.1 percent for cTn-I; 87 percent for cTn-T; 85.1 percent for ex-ECG; 93.4 percent for ex-Echo; 98.5 percent for PhSE; 89.4 percnet for ex-SPECT-Tc; and 18.7 percent for CA.

The researchers found that the average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to one (as a cost comparator), the relative cost of ex-Echo is 1.5x; of a ex-SPECT-Tc is 3.1x; of a ex-ECG is 3.5x; of cTnI is x3.8; of cTnT is x3.9; and of a CA is 56.3x.

Bedetti and colleagues found that the cost per patient correctly identified results $2.051 for cTn-I; $2.086 for cTn-T; $1.890 for ex-ECG; $803 for ex-Echo; $533 for PhSE; $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer); and $29.673 for CA ($29.999 including cost of extra risk of cancer).