ABSTRACT
AIM: To select optimal methods of coronary heart disease (CHD) diagnosis in patients with different CHD probability using cost-effect analysis. MATERIAL AND METHODS: The trial included 102 patients admitted to hospital because of suspected CHD. The initial CHD probability was determined according to G.A. Diamond table. CHD diagnosis was made with application of Holter ECG monitoring (88 patients), treadmill test (67 patients), dobutamine stress echocardiography (echo-CG, 31 patients), stress single photon emission computed tomography (SPECT, 30 patients), multislice computed tomography (MSCT) with contrast study of coronary arteries (14 patients). Non-invasive tests were followed by coronaroangiography. The cost-effect method was used for analysis of the above methods cost efficacy. RESULTS: MSCT specificity was 96%, specificity of the other methods - 70-75%. SPECT was most sensitive (96%), Holter ECG monitoring was the least sensitive (49%). Efficacy of all the diagnostic tests was maximal in moderate probability of CHD. In spite of its moderate specificity and sensitivity, treadmill test was the cheapest and, therefore, most cost effective in all the groups. Specification of CHD probability by 1% required 17.4 roubles in low risk groups, 9.4 and 24.7 roubles in moderate and high risk, respectively. CONCLUSION: CHD diagnosis should be started with treadmill test.
Subject(s)
Coronary Disease/diagnosis , Echocardiography, Stress/economics , Electrocardiography, Ambulatory/economics , Exercise Test/economics , Spiral Cone-Beam Computed Tomography/economics , Adult , Aged , Coronary Disease/economics , Cost-Benefit Analysis/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Russia , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
The clinical economical analysis was applied to assess the application of different techniques of ischemic heart disease diagnostics - the electro-cardiographic monitoring, the treadmill-testing, the stress-echo cardiographic with dobutamine, the single-photon computerized axial tomography with load, the multi-spiral computerized axial tomography with coronary arteries staining in patients with different initial probability of disease occurrence. In all groups, the best value of "cost-effectiveness" had the treadmill-test. The patients with low risk needed 17.4 rubles to precise the probability of ischemic heart disease occurrence at 1%. In the group with medium and high risk this indicator was 9.4 and 24.7 rubles correspondingly. It is concluded that to precise the probability of ischemic heart disease occurrence after tredmil-test in the patients with high probability it is appropriate to use the single-photon computerized axial tomography with load and in the case of patients with low probability the multi-spiral computerized axial tomography with coronary arteries staining.
Subject(s)
Diagnostic Techniques and Procedures/economics , Health Care Costs , Health Services/economics , Myocardial Ischemia/diagnosis , Myocardial Ischemia/economics , Adult , Aged , Costs and Cost Analysis , Humans , Middle Aged , Models, Biological , RussiaABSTRACT
The aim of the study was to determine effective diagnostic methods for use in patients with different probabilities of coronary artery disease (CAD). The 102 subjects were distributed into 3 groups according to CAD risk: low risk (n = 13), moderate risk (n = 29), and high risk (n = 60). The following examinations were performed: Holter ECG monitoring (88 patients), treadmill test (67 patients), stress-echoCG with dobutamine (31 patients), single phase emission computed tomography (SFECT) (30 patients), and multispiral computed tomography (MSCT) with coronary arterial contrasting (14 patients). After non-invasive tests, all patients underwent coronaroangiography. According to the study, MSCT and SPECT were the most effective techniques for CAD diagnostics. The application of all these tests is justified most in cases of moderate risk of stenosing coronary arterial lesion.
