Journal of Cardiovascular Computed Tomography
Volume 3, Issue 5 , Pages 323-330, September 2009

Cost-effectiveness of multidetector computed tomography compared with myocardial perfusion imaging as gatekeeper to invasive coronary angiography in asymptomatic firefighters with positive treadmill tests

  • Matthew J. Budoff, MD, FACC

      Affiliations

    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
    • Corresponding Author InformationCorresponding author.
    • ,
  • Robert Karwasky, MS

      Affiliations

    • Los Angeles County Fire Department, Los Angeles, CA, USA
    • ,
  • Naser Ahmadi, MD

      Affiliations

    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
    • ,
  • Cyrus Nasserian, BS

      Affiliations

    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
    • ,
  • Frank Pratt, MD

      Affiliations

    • Los Angeles County Fire Department, Los Angeles, CA, USA
    • ,
  • Jamey Stephens, FNP-C

      Affiliations

    • Los Angeles County Fire Department, Los Angeles, CA, USA
    • ,
  • William W. Chang, BS

      Affiliations

    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
    • ,
  • Ferdinand R. Flores, BS

      Affiliations

    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
    • ,
  • John A. Rizzo, PhD

      Affiliations

    • Department of Preventive Medicine and Department of Economics, State University of New York, Stony Brook, NY, USA
    • ,
  • Candace L. Gunnarsson, EdD

      Affiliations

    • S2 Statistical Solutions, Inc, Cincinnati, OH, USA
    • ,
  • Charles R. McKay, MD

      Affiliations

    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA

Received 13 April 2009; accepted 4 August 2009. published online 17 August 2009.

Background

In a prospective evaluation of 3950 Los Angeles County firefighters who underwent wellness/fitness examinations, 495 firefighters had abnormal treadmill tests and were referred for cardiology evaluation. Cost of the traditional myocardial perfusion imaging (MPI) followed by invasive coronary angiography (ICA) was compared with a method incorporating 64-slice multidetector computed tomography (MDCT) with coronary calcium score (CCS) followed by computed tomographic angiography (CTA) and ICA as indicated.

Objective

We compared the costs of 2 methods of predicting coronary artery disease (CAD) by ICA among asymptomatic patients with positive treadmill tests.

Methods

A decision-analytic framework was used to compare the net direct costs of CAD diagnosis associated with MDCT versus MPI. In the MDCT arm, all received CCS followed by CTA for those with calcium scores>10 and ICA for those with ≥50% stenosis on CTA. For the MPI arm, results were estimated from prior years' experience, in which firefighters with abnormal treadmill results were referred to ICA.

Results

Of 495 firefighters, 131 (26.9%) had abnormal CCS and went to CTA; 40 (8.1%) had ≥50% stenosis on CTA and went to ICA. According to prior years' experience with MPI, 146 (29.5%) would have shown abnormalities requiring ICA. Average cost was $1376/person for MPI versus $503/person for CCS with or without CTA as gatekeeper. All sensitivity analyses showed lower costs for the MDCT pathway compared with MPI.

Conclusion

In this firefighter population, the cost of ICA-confirmed diagnosis of CAD is substantially lower with MDCT as gatekeeper than with MPI.

Keywords: Cost-effectiveness, CT angiography, Diagnosis, Nuclear testing

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Conflict of interest: Dr. Budoff is a member of the GE Speakers' Bureau. The other authors report no conflicts of interest.

 This study was supported by GE Healthcare. GE Healthcare had no role in the study design or in the collection of data. GE Healthcare provided support to S2 Statistical Solutions, Inc, (Cincinnati, OH) for independent statisticians (C.L. Gunnarsson and J.A. Rizzo) to perform the statistical and cost analyses, and to an independent medical writer (J.K. Noel) to assist Dr. Budoff in the drafting of the manuscript, based on an outline, results, and references provided by the study authors, but GE Healthcare had no role in drafting or editing the manuscript or in the decision to submit the paper for publication.

PII: S1934-5925(09)00410-9

doi:10.1016/j.jcct.2009.08.004

Journal of Cardiovascular Computed Tomography
Volume 3, Issue 5 , Pages 323-330, September 2009

Article Tools

* Image Usage & Resolution