Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy,
Radiol Med. 2013 Dec;118(8):1294-308. doi: 10.1007/s11547-013-0933-z. Epub 2013 May 27.
This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup.
Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary).
Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol.
The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.
本研究评估了与传统诊断方法相比，在疑似冠心病（CAD）患者的诊断管理中引入多排螺旋 CT 冠状动脉造影（MDCT-CA）的增量价值和成本效益比。
考虑了 2009 年 1 月至 2011 年 6 月期间接受 MDCT-CA 的 550 例连续患者。对具有非典型胸痛和疑似阻塞性 CAD 的患者，指导其选择以下两种诊断途径之一：传统方案（检查、负荷试验、CA）和当前方案（检查、负荷试验、MDCT-CA 和 CA，如有必要）。计算了每个方案和单个方法的成本。基于结果，比较了两种诊断途径的成本效益比。提出了第三种改良诊断途径及其相对成本效益比（检查、MDCT-CA、负荷试验和 CA，如有必要）。
与 MDCT-CA 相比，负荷试验的准确性为 66%，灵敏度和特异性分别为 21%和 87%，阳性（PPV）和阴性（NPV）预测值分别为 40%和 70%。与传统冠状动脉造影（CCA）相比，MDCT-CA 的灵敏度和特异性分别为 92%和 89%，PPV 和 NPV 分别为 89%和 92%，准确性为 92%。传统方案的成本高于第二个方案：1645 欧元对 322 欧元（平均值），但显示出更好的成本效益比。新提出的方案成本更低，平均为 261 欧元，与传统方案相比具有更好的成本效益比。
通过引入 MDCT-CA，对疑似 CAD 患者的诊断方案进行了修改。本研究证实，与负荷试验相比，MDCT-CA 具有更高的诊断性能，与 CCA 的准确性相似。使用 MDCT-CA 选择进行 CCA 的患者具有有利的成本效益比。
