Multidetector coronary computed tomographic angiography (CCTA) demonstrates high accuracy
for the detection and exclusion of coronary artery disease (CAD) and predicts adverse
prognosis. To date, opportunity costs relating the clinical and economic outcomes
of CCTA compared with other methods of diagnosing CAD, such as myocardial perfusion
single-photon emission computed tomography (SPECT), remain unknown. An observational,
multicenter, patient-level analysis of patients without known CAD who underwent CCTA
or SPECT was performed. Patients who underwent CCTA (n = 1,938) were matched to those
who underwent SPECT (n = 7,752) on 8 demographic and clinical characteristics and
2 summary measures of cardiac medications and co-morbidities and were evaluated for
9-month expenditures and clinical outcomes. Adjusted total health care and CAD expenditures
were 27% (p <0.001) and 33% (p <0.001) lower, respectively, for patients who underwent
CCTA compared with those who underwent SPECT, by an average of $467 (95% confidence
interval $99 to $984) for CAD expenditures per patient. Despite lower total health
care expenditures for CCTA, no differences were observed for rates of adverse cardiovascular
events, including CAD hospitalizations (4.2% vs 4.1%, p = NS), CAD outpatient visits
(17.4% vs 13.3%, p = NS), myocardial infarction (0.4% vs 0.6%, p = NS), and new-onset
angina (3.0% vs 3.5%, p = NS). Patients without known CAD who underwent CCTA, compared
with matched patients who underwent SPECT, incurred lower overall health care and
CAD expenditures while experiencing similarly low rates of CAD hospitalization, outpatient
visits, myocardial infarction, and angina. In conclusion, these data suggest that
CCTA may be a cost-efficient alternative to SPECT for the initial coronary evaluation
of patients without known CAD.
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Article info
Publication history
Published online: June 19, 2008
Accepted:
April 23,
2008
Received in revised form:
April 23,
2008
Received:
February 25,
2008
Footnotes
This study was funded by an unrestricted educational grant from GE Healthcare, Chalfont St. Giles, United Kingdom.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
