Cost-effectiveness analysis in diagnosis of cardiac disease: overview of its rationale and method.

This article reviews selected literature that can be useful for analysis of cost-effectiveness (CE) of diagnostic procedures in patients with known or suspected coronary artery disease. First, a clinical example illustrates some of the issues involved. Four questions are used to organize the material: (1) What is CE analysis? (2) Why should we use CE analysis? (3) Who should perform CE analysis? and (4) How should CE analysis be performed? (1) What is CE analysis? CE analysis differs from cost-reduction or cost-benefit analysis but may encompass cost-utility analysis. Marginal CE emphasizes differences in CE between different strategies. (2) Why should we use CE analysis? Nuclear cardiology depends on the fruits of medical technology, and many policy makers blame technology for escalating costs of health care. This situation requires us to reduce the absolute cost or the increment in cost, as well as to assess the true value of the technology we use. (3) Who should perform CE analysis? A team approach is the best answer to combine the expertise from clinicians and economists. A team approach and detailed definitions of assumptions can help minimize potential bias. (4) How should CE analysis be performed? CE analysis requires formulating important questions, designing alternative scenarios or strategies, selecting values for the numeric variables and including the probability that an event will occur, calculating cost per outcome, and sensitivity analysis of the model. The appropriate goal of CE analysis of the clinical use of cardiac imaging procedures is, first, to help improve patient outcome and, second, to limit costs.