Cost-effectiveness of myocardial perfusion SPECT and stress test according to coronary revascularization therapy, cardiac events and total mortality: Register of 8,496 patients
| Autor: | G, Romero-Farina, J B, Montoro-Ronsano, S, Aguadé-Bruix, J, Candell-Riera |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Tomography Emission-Computed Single-Photon Cost-Benefit Analysis Rest Myocardial Infarction Myocardial Ischemia Myocardial Perfusion Imaging Middle Aged Patient Readmission Sensitivity and Specificity Percutaneous Coronary Intervention Cardiovascular Diseases Recurrence Exercise Test Myocardial Revascularization Humans Female Prospective Studies Quality-Adjusted Life Years Coronary Artery Bypass Aged Follow-Up Studies |
| Zdroj: | Revista espanola de medicina nuclear e imagen molecular. 39(4) |
| ISSN: | 2253-8089 |
| Popis: | The aim was to analyze the cost-effectiveness ratio (CER) of stress electrocardiogram (ES) and stress myocardial perfusion imaging (SPECT-MPI) according to coronary revascularization (CR) therapy, cardiac events (CE) and total mortality (TM).A total of 8,496 consecutive patients who underwent SPECT-MPI were followed-up (mean 5.3±3.5years). Cost-effectiveness for coronary bypass (CABG) or percutaneous CR (PCR) (45.6%/54.4%) according to combined electrocardiographic ischemia and scintigraphic ischemia were evaluated. Effectiveness was evaluated as TM, CE, life-year saved observed (LYSO) and CE-LYSO; costs analyses were conducted from the perspective of the health care payer. A sensitivity analysis was performed considering current CABG/PCR ratios (12%/88%).When electrocardiogram and SPECT approaches are combined, the cost-effectiveness values for CABG ranged between 112,589€ (electrocardiographic and scintigraphic ischemia) and 2,814,715€ (without ischemia)/event avoided, 38,664 and 2,221,559€/LYSO; for PCR ranged between 18,824€ (electrocardiographic and scintigraphic ischemia) and 46,377€ (without ischemia)/event avoided, 6,464 and 36,604€/LYSO. To CE: the cost-effectiveness values of the CABG and CPR in presence of electrocardiographic and scintigraphic ischemia were 269,904€/CE-avoided and 24,428€/CE-avoided, respectively; and the €/LYSO of the CABG and PCR were 152,488 and 13,801, respectively. The RCE was maintained for the current proportion of revascularized patients (12%/88%).Combined ES and SPECT-MPI results, allows differentiation between patient groups, where the PCR and CABG are more cost-effective in different economic frameworks. The major CER in relation to CR, CE and TM occurs in patients with electrocardiographic and scintigraphic ischemia. PCR is more cost-effective than CABG. |
| Databáze: | OpenAIRE |
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