Noninvasive imaging for the diagnosis of coronary artery disease: focusing the development of new diagnostic technology |
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Authors: | Hunink M G Kuntz K M Fleischmann K E Brady T J |
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Affiliation: | Erasmus Medical Center Rotterdam, The Netherlands. hunink@epib.fgg.eur.nl |
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Abstract: | BACKGROUND: New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease. OBJECTIVE: To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests. DESIGN: Decision model and cost-effectiveness analysis. DATA SOURCES: Literature review and meta-analysis. TARGET POPULATION: 55-year-old men and 65-year-old women presenting with chest pain. TIME HORIZON: Lifetime of the patient. PERSPECTIVE: Health care policy. INTERVENTIONS: MRI, electron-beam CT, exercise echocardiography, exercise single-photon emission CT, and coronary angiography. OUTCOME MEASURES: Target sensitivity and specificity values for a new noninvasive test. RESULTS OF BASE-CASE ANALYSIS: Assuming that society is willing to pay $75000 per quality-adjusted life-year (QALY) gained, a new test that costs $1000 would need a sensitivity of 94% and a specificity of 90% to be cost-effective. RESULTS OF SENSITIVITY ANALYSIS: Assuming that society is willing to pay $50000 per QALY gained, a new test that costs $1000 or more would never be cost-effective. For a test that costs $500, the sensitivity and specificity must each be 95%. CONCLUSIONS: New imaging techniques, such as MRI and electron-beam CT, must be relatively inexpensive and have excellent sensitivity and specificity to be cost-effective compared with other techniques for the diagnosis of coronary artery disease. Similar analyses in other areas of health care may help to focus the development of new diagnostic technology. |
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