Measuring Diagnostic Health Care Costs in Stable Coronary Artery Disease: Should We Follow the Money?
Authors: Joe X. Xie, Leslee J. Shaw
Journal: Annals of Internal Medicine (2016)

Editorials19 July 2016Measuring Diagnostic Health Care Costs in Stable Coronary Artery Disease: Should We Follow the Money?Joe X. Xie, MD and Leslee J. Shaw, PhDJoe X. Xie, MDFrom Emory Clinical Cardiovascular Clinical Research Institute, Emory University School of Medicine, Atlanta, Georgia. and Leslee J. Shaw, PhDFrom Emory Clinical Cardiovascular Clinical Research Institute, Emory University School of Medicine, Atlanta, Georgia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1048 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The field of diagnostic testing in the evaluation of suspected coronary artery disease (CAD) is often criticized for having insufficient comparative clinical and cost-effectiveness evidence to inform health policies for the use of noninvasive tests (1). However, recent trials, including PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain), have been published that compared strategies of functional stress testing with noninvasive anatomical testing using coronary computed tomography angiography (CTA) (2, 3). PROMISE revealed similar 3.5-year outcomes regardless of whether stress testing or CTA was initially performed. Accordingly, differential patterns of cost or resource consumption gain importance because certain strategies ...References1. Mark DB, Anderson JL, Brinker JA, Brophy JA, Casey DE, Cross RR, et al. ACC/AHA/ASE/ASNC/HRS/IAC/Mended Hearts/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR/SNMMI 2014 health policy statement on use of noninvasive cardiovascular imaging: a report of the American College of Cardiology Clinical Quality Committee. J Am Coll Cardiol. 2014;63:698-721. [PMID: 24556329] doi:10.1016/j.jacc.2013.02.002 CrossrefMedlineGoogle Scholar2. Douglas PS, Hoffmann U. Anatomical versus functional testing for coronary artery disease [Letter]. N Engl J Med. 2015;373:91. [PMID: 26132947] doi:10.1056/NEJMc1505594 CrossrefMedlineGoogle Scholar3. SCOT-HEART investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015;385:2383-91. [PMID: 25788230] doi:10.1016/S0140-6736(15)60291-4 CrossrefMedlineGoogle Scholar4. Mark DB, Federspiel JJ, Cowper PA, Anstrom KJ, Hoffmann U, Patel MR, et al; PROMISE Investigators. Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. Ann Intern Med. 2016;165:94-102. doi:10.7326/M15-2639 LinkGoogle Scholar5. Genders TS, Petersen SE, Pugliese F, Dastidar AG, Fleischmann KE, Nieman K, et al. The optimal imaging strategy for patients with stable chest pain: a cost-effectiveness analysis. Ann Intern Med. 2015;162:474-84. [PMID: 25844996]. doi:10.7326/M14-0027 LinkGoogle Scholar6. Shreibati JB, Baker LC, Hlatky MA. Association of coronary CT angiography or stress testing with subsequent utilization and spending among Medicare beneficiaries. JAMA. 2011;306:2128-36. [PMID: 22089720] doi:10.1001/jama.2011.1652 CrossrefMedlineGoogle Scholar7. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al; American College of Cardiology Foundation. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44-e164. [PMID: 23182125] doi:10.1016/j.jacc.2012.07.013 CrossrefMedlineGoogle Scholar8. Shaw LJ, Mieres JH, Hendel RH, Boden WE, Gulati M, Veledar E, et al; WOMEN Trial Investigators. Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation. 2011;124:1239-49. [PMID: 21844080] doi:10.1161/CIRCULATIONAHA.111.029660 CrossrefMedlineGoogle Scholar9. Hachamovitch R, Nutter B, Hlatky MA, Shaw LJ, Ridner ML, Dorbala S, et al; SPARC Investigators. Patient management after noninvasive cardiac imaging results from SPARC (Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in Coronary Artery Disease). J Am Coll Cardiol. 2012;59:462-74. [PMID: 22281249] doi:10.1016/j.jacc.2011.09.066 CrossrefMedlineGoogle Scholar10. Williams MC, Hunter A, Shah AS, Assi V, Lewis S, Smith J, et al; SCOT-HEART Investigators. Use of coronary computed tomographic angiography to guide management of patients with coronary disease. J Am Coll Cardiol. 2016;67:1759-68. [PMID: 27081014] doi:10.1016/j.jacc.2016.02.026 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Emory Clinical Cardiovascular Clinical Research Institute, Emory University School of Medicine, Atlanta, Georgia.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1048.Corresponding Author: Leslee J. Shaw, PhD, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, GA 30324.Current Author Addresses: Drs. Xie and Shaw: Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Atlanta, GA 30324.This article was published at www.annals.org on 24 May 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEconomic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease Daniel B. Mark , Jerome J. Federspiel , Patricia A. Cowper , Kevin J. Anstrom , Udo Hoffmann , Manesh R. Patel , Linda Davidson-Ray , Melanie R. Daniels , Lawton S. Cooper , J. David Knight , Kerry L. Lee , Pamela S. Douglas , and Metrics Cited bySCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed TomographyDefining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart AssociationHealthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed TomographyMyocardial perfusion imaging in women for the evaluation of stable ischemic heart disease—state-of-the-evidence and clinical recommendationsComparative Effectiveness Trials of Imaging-Guided Strategies in Stable Ischemic Heart Disease 19 July 2016Volume 165, Issue 2Page: 147-148KeywordsAngiographyCoronary revascularizationDisclosureElectrocardiographyHealth careIschemiaPreventive medicineRevascularizationStable coronary artery diseaseTreatment guidelines ePublished: 24 May 2016 Issue Published: 19 July 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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