Diagnosis of suspected coronary artery disease in women: a cost-effectiveness analysis

Am Heart J. 1999 Jun;137(6):1019-27. doi: 10.1016/s0002-8703(99)70357-1.

Abstract

Background: The optimal strategy for the diagnosis of coronary artery disease (CAD) in women is not well defined. We compared the cost-effectiveness of several strategies for diagnosing CAD in women with chest pain.

Methods: We performed decision and cost-effectiveness analyses with simulations of 55-year-old ambulatory women with chest pain. With a Markov model, simulations of patients underwent exercise electrocardiography, exercise testing with thallium scintigraphy, exercise echocardiography, angiography, or no workup.

Results: Diagnosis with angiography cost less than $17, 000 per quality-adjusted life-year compared with exercise echocardiography if the patient had definite angina and less than $76,000 per life-year if she had probable angina. If she had nonspecific chest pain, diagnosis with exercise echocardiography increased life-years compared with no testing.

Conclusions: Cost-effectiveness of first-line diagnostic strategy for diagnosis of CAD in women varies mostly according to pretest probability of CAD. Diagnosis of coronary artery disease with angiography is cost-effective in 55-year-old women with definite angina. In 55-year-old women with probable angina, diagnosis with angiography would increase quality-adjusted life-years but significantly increase costs. Use of exercise echocardiography as a first-line diagnosis for CAD is cost effective in 55-year-old women with probable angina and nonspecific chest pain.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Angina Pectoris / diagnosis
  • Angina Pectoris / economics
  • Angina Pectoris / therapy
  • Angioplasty, Balloon, Coronary / economics
  • Angioplasty, Balloon, Coronary / statistics & numerical data
  • California
  • Chest Pain / diagnosis
  • Chest Pain / economics
  • Chest Pain / therapy
  • Coronary Artery Bypass / economics
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Disease / diagnosis*
  • Coronary Disease / economics*
  • Coronary Disease / therapy
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • Health Care Costs
  • Humans
  • Markov Chains
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / economics
  • Myocardial Infarction / therapy
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity