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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Cost-effectiveness of myocardial perfusion SPECT and stress test according to co...
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Vol. 39. Issue 4.
Pages 212-219 (July - August 2020)
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Vol. 39. Issue 4.
Pages 212-219 (July - August 2020)
Original Article
Cost-effectiveness of myocardial perfusion SPECT and stress test according to coronary revascularization therapy, cardiac events and total mortality: Register of 8496 patients
Coste-efectividad de la SPECT de perfusión miocárdica y de la prueba de esfuerzo en relación con la revascularización coronaria, eventos cardíacos y mortalidad total. Registro de 8.496 pacientes
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G. Romero-Farinaa,b,
Corresponding author
, J.B. Montoro-Ronsanoc, S. Aguadé-Bruixb, J. Candell-Rieraa
a Departamento de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
b Departamento de Medicina Nuclear, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
c Departamento de Farmacia, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Tables (6)
Table 1. Costs and sources of costs.
Table 2. Baseline characteristics of the surviving patients and total mortality.
Table 3. Baseline characteristics of the patients with and without a cardiac event.
Table 4. Effectiveness of SPECT and stress electrocardiogram for differentiating revascularized populations with different cost-effectiveness values measured in € for event avoided and € for life-years saved observed.
Table 5. Value of cost-effecctiveness for coronary revascularization in each group identified with the incremental cost of SPECT including the cost of coronary revascularization.
Table 6. Analysis of sensitivity using the real proportion between surgical coronary revascularization and percutaneous coronary revascularization for the cost-effectiveness ratio of SPECT and the true value of cost-effectiveness of coronary revascularization in each group identified.
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Abstract
Objective

The aim was to analyze the cost-effectiveness ratio (CER) of stress electrocardiogram (ES) and stress myocardial perfusion imaging (SPECT-MPI) according to coronary revascularization (CR) therapy, cardiac events (CE) and total mortality (TM).

Material and methods

A total of 8496 consecutive patients who underwent SPECT-MPI were followed-up (mean 5.3±3.5 years). Cost-effectiveness for coronary bypass (CABG) or percutaneous CR (PCR) (45.6%/54.4%) according to combined electrocardiographic ischemia and scintigraphic ischemia were evaluated. Effectiveness was evaluated as TM, CE, life-year saved observed (LYSO) and CE-LYSO; costs analyses were conducted from the perspective of the health care payer. A sensitivity analysis was performed considering current CABG/PCR ratios (12%/88%).

Results

When electrocardiogram and SPECT approaches are combined, the cost-effectiveness values for CABG ranged between 112,589€ (electrocardiographic and scintigraphic ischemia) and 2,814,715€ (without ischemia)/event avoided, 38,664 and 2,221,559€/LYSO; for PCR ranged between 18,824€ (electrocardiographic and scintigraphic ischemia) and 46,377€ (without ischemia)/event avoided, 6464 and 36,604€/LYSO. To CE: the cost-effectiveness values of the CABG and CPR in presence of electrocardiographic and scintigraphic ischemia were 269,904€/CE-avoided and 24,428€/CE-avoided, respectively; and the €/LYSO of the CABG and PCR were 152,488 and 13,801, respectively. The RCE was maintained for the current proportion of revascularized patients (12%/88%).

Conclusions

Combined ES and SPECT-MPI results, allows differentiation between patient groups, where the PCR and CABG are more cost-effective in different economic frameworks. The major CER in relation to CR, CE and TM occurs in patients with electrocardiographic and scintigraphic ischemia. PCR is more cost-effective than CABG.

Keywords:
Exercise test
SPECT
Coronary revascularization
Cardiac event
Total mortality
Cost-effectiveness ratio
Resumen
Objetivo

Análisis de la relación coste-efectividad (RCE) del electrocardiograma de esfuerzo y de la SPECT de perfusión miocárdica esfuerzo-reposo en relación con la revascularización coronaria (RC), eventos cardíacos (EC) y mortalidad total (MT).

Material y métodos

Se estudiaron 8.496 pacientes con SPECT y seguimiento medio de 5,3±3,5años. Evaluamos la RCE para la RC quirúrgica (RCQ) y percutánea (RCP) (45,6%/54,4%) de acuerdo con los resultados de la isquemia electrocardiográfica y gammagráfica. La efectividad se evaluó como MT, EC, LYSO (life-year-saved-observed) y EC-LYSO. Los análisis de costes se realizaron desde la perspectiva del pagador de atención médica. El análisis de sensibilidad fue considerando las relaciones RCQ/RCP actuales (12%/88%).

Resultados

Al combinar los resultados del electrocardiograma de esfuerzo y de la gammagrafía, los valores de coste-efectividad para la RCQ variaron entre 112.589€ (isquemia electrocardiográfica y gammagráfica) y 2.814.715€ (sin isquemia)/evento evitado, y entre 38.664 y 2.221.559€/LYSO; y para la RCP entre 18.824€ (isquemia electrocardiográfica y gammagráfica) y 46.377€ (sin isquemia)/evento evitado, y entre 6.464 y 36.604€/LYSO. Para el EC: los valores de coste-efectividad de la RCQ y RCP en presencia de isquemia electrocardiográfica y gammagráfica fueron de 269.904€/EC evitado y de 24.428€/EC evitado, respectivamente; y los €/LYSO de la RCQ y RCP fueron de 152.488 y 13.801, respectivamente. Se mantuvo la misma RCE para la proporción actual de pacientes revascularizados (12%/88%).

Conclusiones

El análisis combinado de las imágenes de la SPECT y del electrocardiograma de esfuerzo permite la diferenciación entre grupos de pacientes en donde la RCP y la RCQ son más rentables. La mayor RCE en relación con la RC, EC y MT se da en los pacientes con isquemia electrocardiográfica y gammagráfica. La RCP es más coste-efectiva que la RCQ.

Palabras clave:
ECG de estrés
SPECT
Revascularización coronaria
Evento cardiaco
Mortalidad total
Relación coste-efectividad

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