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Cost-Effectiveness of Screening Strategies for Left Main Coronary Artery Disease in Patients with Stable Angina

Author

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  • Thomas H. Lee
  • Tsuguya Fukui
  • Milton C. Weinstein
  • Anna N.A. Tosteson
  • Lee Goldman

Abstract

To define optimal strategies for screening for left main coronary artery disease (LMCAD), the authors evaluated the cost-effectiveness of exercise tolerance testing and cardiac cath eterization in patients with mild stable chest pain, such as patients with definite or probable angina in the Coronary Artery Surgery Study registry (prevalence of LMCAD = 9%). Per formance characteristics of the exercise test, operative mortality, long- term survival rates, and rates of crossing over to surgical therapy for patients initially managed with medical therapy were derived from pooled literature data; cost estimates were based on local charge data. Strategies using the exercise test to identify candidates for catheterization were as sociated with longer life expectancies than either the conservative strategy in which patients would be observed or the more aggressive strategy in which all patients would undergo coronary angiography. The most cost-effective option was to screen patients with an exercise test and to perform catheterization in patients with ≥ 2 mm of ST-segment change. Compared with a strategy of catheterization for ≥ 3 mm of ST-segment change only, this strategy increased life expectancy at marginal costs per year of life saved ranging from $11,263 to $18,100 for 40- to 70-year-old patients, respectively, while, compared with a strategy of observation unless symptoms worsened, its incremental cost-effectiveness was $6,510 to $12,428 per year of life saved. Thus, screening patients with stable chest pain syndromes with exercise tests and performing catheterization for patients with ≥ 2 mm of ST-segment change has cost-effectiveness comparable to that of the treatment of moderate diastolic hypertension. Key words: cost-effectiveness; chest pain; angina; exercise testing; coronary artery surgery; screening. (Med Decis Making 8:268-278, 1988)

Suggested Citation

  • Thomas H. Lee & Tsuguya Fukui & Milton C. Weinstein & Anna N.A. Tosteson & Lee Goldman, 1988. "Cost-Effectiveness of Screening Strategies for Left Main Coronary Artery Disease in Patients with Stable Angina," Medical Decision Making, , vol. 8(4), pages 268-278, December.
    • Handle: RePEc:sae:medema:v:8:y:1988:i:4:p:268-278
    DOI: 10.1177/0272989X8800800408
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    References listed on IDEAS

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    1. Peter Doubilet & Barbara J. McNeil & Milton C. Weinstein, 1985. "The Decision Concerning Coronary Angiography in Patients with Chest Pain," Medical Decision Making, , vol. 5(3), pages 293-309, August.
    2. Thomas H. Lee & E. Francis Cook & Lee Goldman, 1986. "Prospective Evaluation of a Clinical and Exercise-test Model for the Prediction of left Main Coronary Artery Disease," Medical Decision Making, , vol. 6(3), pages 136-144, August.
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    Cited by:

    1. K. Cooper & S. Brailsford & R. Davies & J. Raftery, 2006. "A review of health care models for coronary heart disease interventions," Health Care Management Science, Springer, vol. 9(4), pages 311-324, November.

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