Cost-effectiveness of anatomical and functional test strategies for stable chest pain : public health perspective from a middle-income country
dc.contributor.author | Bertoldi, Eduardo Gehling | pt_BR |
dc.contributor.author | Stella, Steffan Frosi | pt_BR |
dc.contributor.author | Rohde, Luis Eduardo Paim | pt_BR |
dc.contributor.author | Polanczyk, Carisi Anne | pt_BR |
dc.date.accessioned | 2018-03-23T02:27:11Z | pt_BR |
dc.date.issued | 2017 | pt_BR |
dc.identifier.issn | 2044-6055 | pt_BR |
dc.identifier.uri | http://hdl.handle.net/10183/173821 | pt_BR |
dc.description.abstract | Objectives The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). Setting Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation’s public healthcare system. Participants Hypothetical cohort of patients with pretest probability of CAD between 20% and 70%. Primary and secondary outcome measures The primary outcome is cost per correct diagnosis of CAD. Proportion of false-positive or false-negative tests and number of unnecessary tests performed were also evaluated. Results Strategies using Ex-ECG as initial test were the least costly alternatives but generated more frequent false-positive initial tests and false-negative final diagnosis. Strategies based on CTA or ECHO as initial test were the most attractive and resulted in similar cost-effectiveness ratios (I$ 286 and I$ 305 per correct diagnosis, respectively). A strategy based on C-MRI was highly effective for diagnosing stable CAD, but its high cost resulted in unfavourable incremental cost-effectiveness (ICER) in moderate-risk and high-risk scenarios. Noninvasive strategies based on SPECT have been dominated. Conclusions An anatomical diagnostic strategy based on CTA is a cost-effective option for CAD diagnosis. Functional strategies performed equally well when based on ECHO. C-MRI yielded acceptable ICER only at low pretest probability, and SPECT was not cost-effective in our analysis. | en |
dc.format.mimetype | application/pdf | pt_BR |
dc.language.iso | eng | pt_BR |
dc.relation.ispartof | BMJ open. London. Vol. 7, no. 4 (Apr. 2017), e012652, 8 p. | pt_BR |
dc.rights | Open Access | en |
dc.subject | Doença da artéria coronariana | pt_BR |
dc.subject | Análise custo-benefício | pt_BR |
dc.subject | Diagnóstico | pt_BR |
dc.subject | Brasil | pt_BR |
dc.title | Cost-effectiveness of anatomical and functional test strategies for stable chest pain : public health perspective from a middle-income country | pt_BR |
dc.type | Artigo de periódico | pt_BR |
dc.identifier.nrb | 001059872 | pt_BR |
dc.type.origin | Estrangeiro | pt_BR |
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