Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease

PROMISE Investigators

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

Original languageEnglish (US)
Pages (from-to)94-102
Number of pages9
JournalAnnals of internal medicine
Volume165
Issue number2
DOIs
StatePublished - Jul 19 2016

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Coronary Artery Disease
Economics
Costs and Cost Analysis
Chest Pain
Multicenter Studies
Exercise
Medicare
Tiletamine
Fee Schedules
Physicians
Stress Echocardiography
Fees and Charges
Multidetector Computed Tomography
Hospital Costs
Catheterization
Electrocardiography
Outpatients
Computed Tomography Angiography
Databases
Prospective Studies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. / PROMISE Investigators.

In: Annals of internal medicine, Vol. 165, No. 2, 19.07.2016, p. 94-102.

Research output: Contribution to journalArticle

@article{c122b85e44b94e8789a7c9a6e1a5e020,
title = "Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease",
abstract = "Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3{\%} annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95{\%} CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.",
author = "{PROMISE Investigators} and Mark, {Daniel B.} and Federspiel, {Jerome J.} and Cowper, {Patricia A.} and Anstrom, {Kevin J.} and Udo Hoffmann and Patel, {Manesh R.} and Linda Davidson-Ray and Daniels, {Melanie R.} and Cooper, {Lawton S.} and Knight, {J. David} and Lee, {Kerry L.} and Douglas, {Pamela S.} and Robert Bonow and Garnet Anderson and Alain Bertoni and Carr, {J. Jeffrey} and Min, {James K.} and Michael Proschan and Spertus, {John A.} and Ulrich, {Connie M.} and Al-Khalidi, {Hussein R.} and Denise Bonds and Nakela Cook and Dolor, {Rowena J.} and Alan Go and Christopher Fordyce and Tina Harding and Sarah Hayden and Andrzej Kosinski and Krucoff, {Mitchell W.} and Eric Leifer and Beth Martinez and Mudrick, {Daniel W.} and Picard, {Michael H.} and Geoffrey Rubin and Kristen Salvaggio and Schneider, {Ricky M.} and Alexandra Shen and Tardif, {Jean Claude} and Wanda Tate and Udelson, {James E.} and John Vavalle and Velazquez, {Eric J.} and Jyotsna Garg and Megan Huang and Stephanie Wu and Qinghong Yang and Eric Yow and Aijing Zhang and Porter, {Thomas Richard}",
year = "2016",
month = "7",
day = "19",
doi = "10.7326/M15-2639",
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pages = "94--102",
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TY - JOUR

T1 - Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease

AU - PROMISE Investigators

AU - Mark, Daniel B.

AU - Federspiel, Jerome J.

AU - Cowper, Patricia A.

AU - Anstrom, Kevin J.

AU - Hoffmann, Udo

AU - Patel, Manesh R.

AU - Davidson-Ray, Linda

AU - Daniels, Melanie R.

AU - Cooper, Lawton S.

AU - Knight, J. David

AU - Lee, Kerry L.

AU - Douglas, Pamela S.

AU - Bonow, Robert

AU - Anderson, Garnet

AU - Bertoni, Alain

AU - Carr, J. Jeffrey

AU - Min, James K.

AU - Proschan, Michael

AU - Spertus, John A.

AU - Ulrich, Connie M.

AU - Al-Khalidi, Hussein R.

AU - Bonds, Denise

AU - Cook, Nakela

AU - Dolor, Rowena J.

AU - Go, Alan

AU - Fordyce, Christopher

AU - Harding, Tina

AU - Hayden, Sarah

AU - Kosinski, Andrzej

AU - Krucoff, Mitchell W.

AU - Leifer, Eric

AU - Martinez, Beth

AU - Mudrick, Daniel W.

AU - Picard, Michael H.

AU - Rubin, Geoffrey

AU - Salvaggio, Kristen

AU - Schneider, Ricky M.

AU - Shen, Alexandra

AU - Tardif, Jean Claude

AU - Tate, Wanda

AU - Udelson, James E.

AU - Vavalle, John

AU - Velazquez, Eric J.

AU - Garg, Jyotsna

AU - Huang, Megan

AU - Wu, Stephanie

AU - Yang, Qinghong

AU - Yow, Eric

AU - Zhang, Aijing

AU - Porter, Thomas Richard

PY - 2016/7/19

Y1 - 2016/7/19

N2 - Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

AB - Background: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinical outcomes in stable symptomatic patients with suspected coronary artery disease (CAD) requiring noninvasive testing. Objective: To conduct an economic analysis for PROMISE (a major secondary aim of the study). Design: Prospective economic study from the U.S. perspective. Comparisons were made according to the intention-to-treat principle, and CIs were calculated using bootstrap methods. (ClinicalTrials.gov: NCT01174550) Setting: 190 U.S. centers. Patients: 9649 U.S. patients enrolled in PROMISE between July 2010 and September 2013. Median follow-up was 25 months. Measurements: Technical costs of the initial (outpatient) testing strategy were estimated from Premier Research Database data. Hospital-based costs were estimated using hospital bills and Medicare cost-charge ratios. Physician fees were taken from the Medicare Physician Fee Schedule. Costs were expressed in 2014 U.S. dollars, discounted at 3% annually, and estimated out to 3 years using inverse probability weighting methods. Results: The mean initial testing costs were $174 for exercise electrocardiography; $404 for CTA; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. Mean costs at 90 days were $2494 for the CTA strategy versus $2240 for the functional strategy (mean difference, $254 [95% CI, $634 to $906]). The difference was associated with more revascularizations and catheterizations (4.25 per 100 patients) with CTA use. After 90 days, the mean cost difference between the groups out to 3 years remained small. Limitation: Cost weights for test strategies were obtained from sources outside PROMISE. Conclusion: Computed tomography angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up.

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DO - 10.7326/M15-2639

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JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

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