| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1996;94:957-965.)
© 1996 American Heart Association, Inc.
Articles |
Cost-effectiveness of Routine Coronary Angiography After Acute Myocardial Infarction
the Section for Clinical Epidemiology (K.M.K., L.G., M.C.W.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Departments of Biostatistics (M.C.W), Health Policy and Management (K.M.K., M.C.W.), and Epidemiology (L.G.), Harvard School of Public Health, Boston, Mass; Section of Outcomes Research (J.T.), Division of General Internal Medicine, University of Cincinnati Medical Center (Ohio); and Department of Medicine (L.G.), University of California, San Francisco School of Medicine.
Correspondence to Karen M. Kuntz, ScD, Section for Clinical Epidemiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail keaney@hsph.harvard.edu.
Background Coronary angiography is indicated for many patients after acute myocardial infarction (AMI). There are a number of subgroups of AMI patients, however, for whom the indication for coronary angiography is not well established.
Methods and Results We developed a decision-analytic model for AMI in representative patient subgroups based on relevant clinical characteristics. The model estimates quality-adjusted life expectancy and direct lifetime costs for two strategies: coronary angiography and treatment guided by its results versus initial medical therapy without angiography. Decision tree chance node probabilities were estimated with the use of pooled data from randomized clinical trials and other relevant literature, costs were estimated with the use of the Medicare Part A database, and quality of life adjustments were derived from a survey of 1051 patients who had had a recent AMI. In our analysis, incremental cost-effectiveness ratios for coronary angiography and treatment guided by its result, compared with initial medical therapy without angiography, ranged between $17 000 and >$1 million per quality-adjusted year of life gained. Patient subgroups with severe postinfarction angina or a strongly positive exercise tolerance test (ETT) typically had cost-effectiveness ratios of <$50 000 per quality-adjusted year of life gained. In addition, most patient subgroups with a prior AMI had cost-effectiveness ratios of <$50 000 per quality-adjusted year of life gained, even with a negative ETT result.
Conclusions In many patient subgroups after AMI, the cost-effectiveness of routine coronary angiography and treatment guided by its results compares favorably with other treatment strategies for coronary heart disease.
Key Words: angiography • coronary disease • cost-effectiveness analysis
This article has been cited by other articles:
 |
|
 |
|
  K. Dalziel and L. Segal Time to give nutrition interventions a higher profile: cost-effectiveness of 10 nutrition interventions Health Promot. Int., December 1, 2007; 22(4): 271 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Lamotte, L. Annemans, B. Bridgewater, S. Kendall, and M. Siebert A health economic evaluation of concomitant surgical ablation for atrial fibrillation Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 702 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Karnon, A. Brennan, and R. Akehurst A Critique and Impact Analysis of Decision Modeling Assumptions Med Decis Making, August 1, 2007; 27(4): 491 - 499. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Dalziel, L. Segal, and M. de Lorgeril A Mediterranean Diet Is Cost-Effective in Patients with Previous Myocardial Infarction J. Nutr., July 1, 2006; 136(7): 1879 - 1885. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Winkelmayer, J. S. Benner, R. J. Glynn, S. Schneeweiss, P. S. Wang, M. A. Brookhart, R. Levin, J. D. Jackson, and J. Avorn Assessing Health State Utilities in Elderly Patients at Cardiovascular Risk Med Decis Making, May 1, 2006; 26(3): 247 - 254. [Abstract] [PDF]
|
|
|
|
 |
|
 T. A. Nahra, K. L. Reiter, R. A. Hirth, J. E. Shermer, and J. R. C. Wheeler Cost-Effectiveness of Hospital Pay-for-Performance Incentives Med Care Res Rev, February 1, 2006; 63(1_suppl): 49S - 72S. [Abstract] [PDF]
|
|
|
|
 |
|
 G. D. Sanders, M. A. Hlatky, and D. K. Owens Cost-Effectiveness of Implantable Cardioverter-Defibrillators N. Engl. J. Med., October 6, 2005; 353(14): 1471 - 1480. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Klein, R. D. Murray, E. R. Becker, S. D. Culler, W. S. Weintraub, S. E. Jasper, E. A. Lieber, C. Apperson-Hansen, A. M. Heerey, R. A. Grimm, et al. Economic analysis of a transesophageal echocardiography-guided approach to cardioversion of patients with atrial fibrillation: The ACUTE economic data at eight weeks J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1217 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Warren, A. Brennan, and R. Akehurst Cost-Effectiveness of Sibutramine in the Treatment of Obesity Med Decis Making, January 1, 2004; 24(1): 9 - 19. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Walker, J. M Sirel, A. K Marsden, S. M Cobbe, and J. P Pell Cost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest BMJ, December 6, 2003; 327(7427): 1316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Prosser, A. A. Stinnett, P. A. Goldman, L. W. Williams, M. G.M. Hunink, L. Goldman, and M. C. Weinstein Cost-Effectiveness of Cholesterol-Lowering Therapies according to Selected Patient Characteristics Ann Intern Med, May 16, 2000; 132(10): 769 - 779. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Kuntz, J. Tsevat, M. C. Weinstein, and L. Goldman Expert Panel vs Decision-Analysis Recommendations for Postdischarge Coronary Angiography After Myocardial Infarction JAMA, December 15, 1999; 282(23): 2246 - 2251. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Neumann, R. C. Hermann, K. M. Kuntz, S. S. Araki, S. B. Duff, J. Leon, P. A. Berenbaum, P. A. Goldman, L. W. Williams, and M. C. Weinstein Cost-effectiveness of donepezil in the treatment of mild or moderate Alzheimer's disease Neurology, April 1, 1999; 52(6): 1138 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Lightwood and S. A. Glantz Short-term Economic and Health Benefits of Smoking Cessation : Myocardial Infarction and Stroke Circulation, August 19, 1997; 96(4): 1089 - 1096. [Abstract] [Full Text]
|
|
|
|
|
|
H. M. Krumholz Cardiac Procedures, Outcomes, and Accountability N. Engl. J. Med., May 22, 1997; 336(21): 1521 - 1523. [Full Text]
|
|
|
|
|
|
L. Goldman The Value of Cardiology N. Engl. J. Med., December 19, 1996; 335(25): 1917 - 1919. [Full Text]
|
|
|
|
|
|
E. L. Eisenstein, D. B. Mark, and R. M. Califf Importance of Cost and Quality of Life in Decisions About Routine Angiography After Acute Myocardial Infarction: The Role of Cost-effectiveness Models Circulation, September 1, 1996; 94(5): 869 - 871. [Full Text]
|
|
|
|
|
|
P. G. Barnett, S. Chen, W. E. Boden, B. Chow, N. R. Every, P. W. Lavori, and M. A. Hlatky Cost-Effectiveness of a Conservative, Ischemia-Guided Management Strategy After Non-Q-Wave Myocardial Infarction: Results of a Randomized Trial Circulation, February 12, 2002; 105(6): 680 - 684. [Abstract] [Full Text] [PDF]
|
|