Publication
Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal
| dc.contributor.author | Ferreira, AM | |
| dc.contributor.author | Marques, H | |
| dc.contributor.author | Araújo Gonçalves, P | |
| dc.contributor.author | Cardim, N | |
| dc.date.accessioned | 2017-09-21T11:47:10Z | |
| dc.date.available | 2017-09-21T11:47:10Z | |
| dc.date.issued | 2014-04 | |
| dc.description.abstract | BACKGROUND: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. OBJECTIVE: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. METHODS: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. RESULTS: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. CONCLUSIONS: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests. | pt_PT |
| dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
| dc.identifier.citation | Arq Bras Cardiol. 2014 Apr;102(4):391-402 | pt_PT |
| dc.identifier.uri | http://hdl.handle.net/10400.17/2756 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.publisher | Sociedade Brasileira de Cardiologia | pt_PT |
| dc.subject | Bayes Theorem | pt_PT |
| dc.subject | Cardiac Imaging Techniques | pt_PT |
| dc.subject | Coronary Artery Disease | pt_PT |
| dc.subject | Cost-Benefit Analysis | pt_PT |
| dc.subject | Decision Trees | pt_PT |
| dc.subject | Exercise Test | pt_PT |
| dc.subject | False Negative Reactions | pt_PT |
| dc.subject | False Positive Reactions | pt_PT |
| dc.subject | Humans | pt_PT |
| dc.subject | Portugal | pt_PT |
| dc.subject | Reference Values | pt_PT |
| dc.subject | Sensitivity and Specificity | pt_PT |
| dc.subject | HSM IMA | pt_PT |
| dc.title | Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.endPage | 402 | pt_PT |
| oaire.citation.issue | 4 | pt_PT |
| oaire.citation.startPage | 391 | pt_PT |
| oaire.citation.title | Arquivos Brasileiros de Cardiologia | pt_PT |
| oaire.citation.volume | 102 | pt_PT |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | article | pt_PT |