Cost effectiveness

Various studies have compared different strategies utilising MPS either as a first line or sole test in the management of patients with symptoms suggestive of IHD. 

The END study (ref 1)

  • Observational study originating from the USA (over 5000 patients in each arm)
  • Comparison between MPS and direct coronary angiography (no ETT performed)
  • MPS guided arm had
    • Lower overall cost
    • Fewer coronary angiograms
    • Lower normal coronary angiogram rate
    • Less revascularisation
    • No difference in cardiac mortality rate

The EMPIRE study (ref 2)

  • Europe-wide retrospective analysis
  • Four strategies were employed using a combination of ETT, MPS and coronary angiography (CA)
  • Diagnostic and management costs were allocated to each strategy
  • Comparing ETT/CA with ETT/MPS/CA
    • No difference in cardiac event rates
    • Overall costs significantly lower using MPS to guide management

Others

  • A prospective comparison between ETT/CA and MPS/CA has been performed (ref 3)
  • Significant reduction in patients given an intermediate post-test likelihood diagnostic label
  • Significant reduction in patients undergoing CA
  • Less expensive to employ MPS, as a first line test for suspicious chest pain, in all patients apart from those with the lowest likelihood of having IHD to begin with

Conclusion

  • Strategies utilising MPS within the diagnostic algorithm are cost effective
  • A normal MPS is reassuring and reduces the need for further expensive & invasive tests.

References 

  1. Shaw LJ, Hachamovitch R, Berman DS, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: An observational assessment of the value of precatheterization ischemia. J Am Coll Cardiol 1999; 33: 661–9. (The END study).
  2. Underwood SR, Godman B, Salyani S, et al. Economics of myocardial perfusion imaging in Europe – the EMPIRE study. Eur Heart J 1999; 20: 157–66.
  3. Sabharwal NK, Stoykova B, Taneja AK, et al. A randomized trial of exercise treadmill ECG versus stress SPECT myocardial perfusion imaging as an initial diagnostic strategy in stable patients with chest pain and suspected CAD: Cost analysis. J Nucl Cardiol 2007; 14: 174–86.

Page last edited: 25 November 2010