Jafari Parvin, Goudarzi Reza, Amiresmaeili Mohammadreza, Rashidinejad Hamidreza
Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Egypt Heart J. 2020 Nov 23;72(1):82. doi: 10.1186/s43044-020-00111-y.
Numerous invasive and noninvasive diagnostic tests with different cost and effectiveness exist for detection of coronary artery disease. This diversity leads to unnecessary utilization of health services. For this reason, this study focused on the cost-effectiveness analysis of diagnostic strategies for coronary artery disease from the perspective of the health care system with 1-year time horizon.
Incremental cost effectiveness ratios of all strategies were less than the threshold except for the electrocardiography-computed tomography angiography-coronary angiography strategy, and cost of the cardiac magnetic resonance imaging-based strategy was higher than the cost of other strategies. Also, the number of correct diagnosis in the electrocardiography-coronary angiography strategy was higher than the other strategies, and its ICER was 15.197 dollars per additional correct diagnosis. Moreover, the sensitivity analysis found that the probability of doing MRI and sensitivity of the exercise electrocardiography had impact on the results.
The most cost-effective strategy for acute patient is ECG-CA strategy, and for chronic patient, the most cost-effective strategies are electrocardiography-single photon emission computed tomography-coronary angiography and electrocardiography-exercise electrocardiography-coronary angiography. Applying these strategies in the same clinical settings may lead to a better utilization of resources.
对于冠状动脉疾病的检测，存在许多具有不同成本和有效性的侵入性和非侵入性诊断测试。这种多样性导致了医疗服务的不必要利用。因此，本研究从医疗保健系统的角度，以1年为时间跨度，重点关注冠状动脉疾病诊断策略的成本效益分析。
除心电图 - 计算机断层扫描血管造影 - 冠状动脉造影策略外，所有策略的增量成本效益比均低于阈值，且基于心脏磁共振成像的策略成本高于其他策略。此外，心电图 - 冠状动脉造影策略的正确诊断数量高于其他策略，其增量成本效益比为每增加一次正确诊断15.197美元。此外，敏感性分析发现进行磁共振成像的概率和运动心电图的敏感性对结果有影响。
对于急性患者，最具成本效益的策略是心电图 - 冠状动脉造影策略；对于慢性患者，最具成本效益的策略是心电图 - 单光子发射计算机断层扫描 - 冠状动脉造影和心电图 - 运动心电图 - 冠状动脉造影。在相同临床环境中应用这些策略可能会更好地利用资源。
