Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis
Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP 0; (C) CCTA in all. We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP 0; (C) angioTC como primeira linha. Desenvolv...
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| Veröffentlicht in: | Revista portuguesa de cardiologia 2023-07, Vol.42 (7), p.617-624 |
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| creator | Gomes, Daniel A. Lopes, Pedro M. Albuquerque, Francisco Freitas, Pedro Silva, Cláudia Guerreiro, Sara Abecasis, João Santos, Ana Coutinho Saraiva, Carla Ferreira, Jorge de Araújo Gonçalves, Pedro Marques, Hugo Mendes, Miguel Ferreira, António M. |
| description | Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP 0; (C) CCTA in all.
We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP 0; (C) angioTC como primeira linha.
Desenvolvemos um modelo de CE com base num estudo transversal em dois centros, incluindo 1385 doentes com dor torácica estável e PPT |
| doi_str_mv | 10.1016/j.repc.2023.03.005 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2791373277</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0870255123001725</els_id><sourcerecordid>2791373277</sourcerecordid><originalsourceid>FETCH-LOGICAL-c400t-69786809c4ea5e7d4eccb6272efd947a839e34115e6ea3190cbb06b0e1283b273</originalsourceid><addsrcrecordid>eNp9UU1v1DAQtRCIrkr_AAfkI5csYzuxE8SlWvElVeICZ8txJq2XbLx4nFb7r_iJOGzhwAFrrGdp3sz4zWPspYCtAKHf7LcJj34rQaotlIDmCdtIYepKgoKnbAOtgUo2jbhgV0R7KEeD6JR-zi6U7pq20d2G_dzFFGeXTtyljAW8m3xYDpx8TMgdccdvXcbviEdMfIzlLinflXdGymG-5WHmR5cDzpn4Q8h3fIoP_JhwzReMvevDFPKJx5HHnnJafA73yP0_k4dA6Ajf8uuSolzhOOJv5oxUvjG76USBXrBno5sIrx7xkn378P7r7lN18-Xj5931TeVrgFzpzrS6hc7X6Bo0Q43e91oaiePQ1ca1qkNVC9GgRqdEB77vQfeAQraql0ZdstfnvkXBj6VIsYdAHqfJzRgXstJ0QhklzUqVZ6pPkSjhaI8pHIoyK8CuZtm9Xc2yq1kWSkBTil499l_6Aw5_S_5YUwjvzgQsKu8DJku-LNnjEFLZix1i-F__X9j_qnM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2791373277</pqid></control><display><type>article</type><title>Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis</title><source>Directory of Open Access Journals - May need to register for free articles</source><source>Alma/SFX Local Collection</source><source>EZB Electronic Journals Library</source><creator>Gomes, Daniel A. ; Lopes, Pedro M. ; Albuquerque, Francisco ; Freitas, Pedro ; Silva, Cláudia ; Guerreiro, Sara ; Abecasis, João ; Santos, Ana Coutinho ; Saraiva, Carla ; Ferreira, Jorge ; de Araújo Gonçalves, Pedro ; Marques, Hugo ; Mendes, Miguel ; Ferreira, António M.</creator><creatorcontrib>Gomes, Daniel A. ; Lopes, Pedro M. ; Albuquerque, Francisco ; Freitas, Pedro ; Silva, Cláudia ; Guerreiro, Sara ; Abecasis, João ; Santos, Ana Coutinho ; Saraiva, Carla ; Ferreira, Jorge ; de Araújo Gonçalves, Pedro ; Marques, Hugo ; Mendes, Miguel ; Ferreira, António M.</creatorcontrib><description>Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP <15%) of obstructive coronary artery disease (CAD), but envisage the use of risk modifiers, such as coronary artery calcium score (CACS), to refine patient selection for testing. We aimed to assess the cost-effectiveness (CE) of three different testing strategies in this population: (A) defer testing; (B) perform CACS, withholding further testing if CACS=0, and proceeding to coronary CT angiography (CCTA) if CACS>0; (C) CCTA in all.
We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP <15% undergoing CACS followed by CCTA. Key input data included the prevalence of obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.1%).
Not testing would correctly classify 89.7% of cases and at a cost of €121433 per 1000 patients. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases and cost €247116/1000 patients. Employing first-line CCTA would correctly classify all patients, at a cost of €271007/1000 diagnosed patients. The added cost for an additional correct diagnosis was €1366 for CACS±CCTA vs. no testing, and €2172 for CCTA vs. CACS±CCTA.
CACS as a gatekeeper for further testing is cost-effective between a threshold of €1366 and €2172 per additional correct diagnosis. CCTA yields the most correct diagnoses and is cost-effective above a threshold of €2172.
As recomendações atuais sugerem não testar por rotina doentes com dor torácica e baixa probabilidade pré-teste (PPT < 15%) de doença arterial coronária (DAC) obstrutiva. No entanto, propõem a utilização de modificadores de risco, como o score de cálcio coronário (ScCa). O objetivo deste trabalho foi avaliar o custo-efetividade (CE) de três estratégias de diagnóstico de DAC nesta população: (A) não testar; (B) realizar ScCa, evitando exames adicionais se ScCa=0, e procedendo a angiotomografia computorizada (angioTC) coronária se ScCa>0; (C) angioTC como primeira linha.
Desenvolvemos um modelo de CE com base num estudo transversal em dois centros, incluindo 1385 doentes com dor torácica estável e PPT<15% submetidos a ScCa seguido de angioTC coronária. As principais variáveis incluíram a prevalência de DAC obstrutiva na angioTC (10,3%), a proporção com ScCa=0 (57%) e o valor preditivo negativo do ScCa para DAC obstrutiva na angioTC (98,1%).
Não testar diagnosticaria corretamente 89,7% dos casos, a um custo de €121.433 por 1.000 doentes. Usar o ScCa como gatekeeper permitiria classificar corretamente 98,9% e custaria €247.116/1.000 doentes. A angioTC como primeira linha diagnosticaria todos os doentes, a um custo de €271.007/1.000 doentes. O custo de um diagnóstico correto adicional foi de €1.366 para ScCa±angioTC versus não testar e €2.172 para angioTC versus ScCa±angioTC.
A estratégia usando ScCa como gatekeeper é custo-efetiva entre um limiar de €1.366 e €2.172 por diagnóstico correto adicional. A angioTC coronária produz a maior taxa de diagnósticos corretos e é custo-efetiva acima de um limiar de €2.172.</description><identifier>ISSN: 0870-2551</identifier><identifier>EISSN: 2174-2030</identifier><identifier>DOI: 10.1016/j.repc.2023.03.005</identifier><identifier>PMID: 36958569</identifier><language>eng</language><publisher>Portugal: Elsevier España, S.L.U</publisher><subject>Angiotomografia computorizada cardíaca ; Coronary artery calcium score ; Coronary artery disease ; Coronary CT angiography ; Cost-effectiveness ; Custo-efetividade ; Diagnosis ; Diagnóstico ; Doença arterial coronária ; Score de cálcio coronário</subject><ispartof>Revista portuguesa de cardiologia, 2023-07, Vol.42 (7), p.617-624</ispartof><rights>2023 Sociedade Portuguesa de Cardiologia</rights><rights>Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-69786809c4ea5e7d4eccb6272efd947a839e34115e6ea3190cbb06b0e1283b273</citedby><cites>FETCH-LOGICAL-c400t-69786809c4ea5e7d4eccb6272efd947a839e34115e6ea3190cbb06b0e1283b273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36958569$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gomes, Daniel A.</creatorcontrib><creatorcontrib>Lopes, Pedro M.</creatorcontrib><creatorcontrib>Albuquerque, Francisco</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Silva, Cláudia</creatorcontrib><creatorcontrib>Guerreiro, Sara</creatorcontrib><creatorcontrib>Abecasis, João</creatorcontrib><creatorcontrib>Santos, Ana Coutinho</creatorcontrib><creatorcontrib>Saraiva, Carla</creatorcontrib><creatorcontrib>Ferreira, Jorge</creatorcontrib><creatorcontrib>de Araújo Gonçalves, Pedro</creatorcontrib><creatorcontrib>Marques, Hugo</creatorcontrib><creatorcontrib>Mendes, Miguel</creatorcontrib><creatorcontrib>Ferreira, António M.</creatorcontrib><title>Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis</title><title>Revista portuguesa de cardiologia</title><addtitle>Rev Port Cardiol</addtitle><description>Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP <15%) of obstructive coronary artery disease (CAD), but envisage the use of risk modifiers, such as coronary artery calcium score (CACS), to refine patient selection for testing. We aimed to assess the cost-effectiveness (CE) of three different testing strategies in this population: (A) defer testing; (B) perform CACS, withholding further testing if CACS=0, and proceeding to coronary CT angiography (CCTA) if CACS>0; (C) CCTA in all.
We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP <15% undergoing CACS followed by CCTA. Key input data included the prevalence of obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.1%).
Not testing would correctly classify 89.7% of cases and at a cost of €121433 per 1000 patients. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases and cost €247116/1000 patients. Employing first-line CCTA would correctly classify all patients, at a cost of €271007/1000 diagnosed patients. The added cost for an additional correct diagnosis was €1366 for CACS±CCTA vs. no testing, and €2172 for CCTA vs. CACS±CCTA.
CACS as a gatekeeper for further testing is cost-effective between a threshold of €1366 and €2172 per additional correct diagnosis. CCTA yields the most correct diagnoses and is cost-effective above a threshold of €2172.
As recomendações atuais sugerem não testar por rotina doentes com dor torácica e baixa probabilidade pré-teste (PPT < 15%) de doença arterial coronária (DAC) obstrutiva. No entanto, propõem a utilização de modificadores de risco, como o score de cálcio coronário (ScCa). O objetivo deste trabalho foi avaliar o custo-efetividade (CE) de três estratégias de diagnóstico de DAC nesta população: (A) não testar; (B) realizar ScCa, evitando exames adicionais se ScCa=0, e procedendo a angiotomografia computorizada (angioTC) coronária se ScCa>0; (C) angioTC como primeira linha.
Desenvolvemos um modelo de CE com base num estudo transversal em dois centros, incluindo 1385 doentes com dor torácica estável e PPT<15% submetidos a ScCa seguido de angioTC coronária. As principais variáveis incluíram a prevalência de DAC obstrutiva na angioTC (10,3%), a proporção com ScCa=0 (57%) e o valor preditivo negativo do ScCa para DAC obstrutiva na angioTC (98,1%).
Não testar diagnosticaria corretamente 89,7% dos casos, a um custo de €121.433 por 1.000 doentes. Usar o ScCa como gatekeeper permitiria classificar corretamente 98,9% e custaria €247.116/1.000 doentes. A angioTC como primeira linha diagnosticaria todos os doentes, a um custo de €271.007/1.000 doentes. O custo de um diagnóstico correto adicional foi de €1.366 para ScCa±angioTC versus não testar e €2.172 para angioTC versus ScCa±angioTC.
A estratégia usando ScCa como gatekeeper é custo-efetiva entre um limiar de €1.366 e €2.172 por diagnóstico correto adicional. A angioTC coronária produz a maior taxa de diagnósticos corretos e é custo-efetiva acima de um limiar de €2.172.</description><subject>Angiotomografia computorizada cardíaca</subject><subject>Coronary artery calcium score</subject><subject>Coronary artery disease</subject><subject>Coronary CT angiography</subject><subject>Cost-effectiveness</subject><subject>Custo-efetividade</subject><subject>Diagnosis</subject><subject>Diagnóstico</subject><subject>Doença arterial coronária</subject><subject>Score de cálcio coronário</subject><issn>0870-2551</issn><issn>2174-2030</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9UU1v1DAQtRCIrkr_AAfkI5csYzuxE8SlWvElVeICZ8txJq2XbLx4nFb7r_iJOGzhwAFrrGdp3sz4zWPspYCtAKHf7LcJj34rQaotlIDmCdtIYepKgoKnbAOtgUo2jbhgV0R7KEeD6JR-zi6U7pq20d2G_dzFFGeXTtyljAW8m3xYDpx8TMgdccdvXcbviEdMfIzlLinflXdGymG-5WHmR5cDzpn4Q8h3fIoP_JhwzReMvevDFPKJx5HHnnJafA73yP0_k4dA6Ajf8uuSolzhOOJv5oxUvjG76USBXrBno5sIrx7xkn378P7r7lN18-Xj5931TeVrgFzpzrS6hc7X6Bo0Q43e91oaiePQ1ca1qkNVC9GgRqdEB77vQfeAQraql0ZdstfnvkXBj6VIsYdAHqfJzRgXstJ0QhklzUqVZ6pPkSjhaI8pHIoyK8CuZtm9Xc2yq1kWSkBTil499l_6Aw5_S_5YUwjvzgQsKu8DJku-LNnjEFLZix1i-F__X9j_qnM</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Gomes, Daniel A.</creator><creator>Lopes, Pedro M.</creator><creator>Albuquerque, Francisco</creator><creator>Freitas, Pedro</creator><creator>Silva, Cláudia</creator><creator>Guerreiro, Sara</creator><creator>Abecasis, João</creator><creator>Santos, Ana Coutinho</creator><creator>Saraiva, Carla</creator><creator>Ferreira, Jorge</creator><creator>de Araújo Gonçalves, Pedro</creator><creator>Marques, Hugo</creator><creator>Mendes, Miguel</creator><creator>Ferreira, António M.</creator><general>Elsevier España, S.L.U</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202307</creationdate><title>Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis</title><author>Gomes, Daniel A. ; Lopes, Pedro M. ; Albuquerque, Francisco ; Freitas, Pedro ; Silva, Cláudia ; Guerreiro, Sara ; Abecasis, João ; Santos, Ana Coutinho ; Saraiva, Carla ; Ferreira, Jorge ; de Araújo Gonçalves, Pedro ; Marques, Hugo ; Mendes, Miguel ; Ferreira, António M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-69786809c4ea5e7d4eccb6272efd947a839e34115e6ea3190cbb06b0e1283b273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Angiotomografia computorizada cardíaca</topic><topic>Coronary artery calcium score</topic><topic>Coronary artery disease</topic><topic>Coronary CT angiography</topic><topic>Cost-effectiveness</topic><topic>Custo-efetividade</topic><topic>Diagnosis</topic><topic>Diagnóstico</topic><topic>Doença arterial coronária</topic><topic>Score de cálcio coronário</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gomes, Daniel A.</creatorcontrib><creatorcontrib>Lopes, Pedro M.</creatorcontrib><creatorcontrib>Albuquerque, Francisco</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Silva, Cláudia</creatorcontrib><creatorcontrib>Guerreiro, Sara</creatorcontrib><creatorcontrib>Abecasis, João</creatorcontrib><creatorcontrib>Santos, Ana Coutinho</creatorcontrib><creatorcontrib>Saraiva, Carla</creatorcontrib><creatorcontrib>Ferreira, Jorge</creatorcontrib><creatorcontrib>de Araújo Gonçalves, Pedro</creatorcontrib><creatorcontrib>Marques, Hugo</creatorcontrib><creatorcontrib>Mendes, Miguel</creatorcontrib><creatorcontrib>Ferreira, António M.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Revista portuguesa de cardiologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gomes, Daniel A.</au><au>Lopes, Pedro M.</au><au>Albuquerque, Francisco</au><au>Freitas, Pedro</au><au>Silva, Cláudia</au><au>Guerreiro, Sara</au><au>Abecasis, João</au><au>Santos, Ana Coutinho</au><au>Saraiva, Carla</au><au>Ferreira, Jorge</au><au>de Araújo Gonçalves, Pedro</au><au>Marques, Hugo</au><au>Mendes, Miguel</au><au>Ferreira, António M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis</atitle><jtitle>Revista portuguesa de cardiologia</jtitle><addtitle>Rev Port Cardiol</addtitle><date>2023-07</date><risdate>2023</risdate><volume>42</volume><issue>7</issue><spage>617</spage><epage>624</epage><pages>617-624</pages><issn>0870-2551</issn><eissn>2174-2030</eissn><abstract>Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP <15%) of obstructive coronary artery disease (CAD), but envisage the use of risk modifiers, such as coronary artery calcium score (CACS), to refine patient selection for testing. We aimed to assess the cost-effectiveness (CE) of three different testing strategies in this population: (A) defer testing; (B) perform CACS, withholding further testing if CACS=0, and proceeding to coronary CT angiography (CCTA) if CACS>0; (C) CCTA in all.
We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP <15% undergoing CACS followed by CCTA. Key input data included the prevalence of obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.1%).
Not testing would correctly classify 89.7% of cases and at a cost of €121433 per 1000 patients. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases and cost €247116/1000 patients. Employing first-line CCTA would correctly classify all patients, at a cost of €271007/1000 diagnosed patients. The added cost for an additional correct diagnosis was €1366 for CACS±CCTA vs. no testing, and €2172 for CCTA vs. CACS±CCTA.
CACS as a gatekeeper for further testing is cost-effective between a threshold of €1366 and €2172 per additional correct diagnosis. CCTA yields the most correct diagnoses and is cost-effective above a threshold of €2172.
As recomendações atuais sugerem não testar por rotina doentes com dor torácica e baixa probabilidade pré-teste (PPT < 15%) de doença arterial coronária (DAC) obstrutiva. No entanto, propõem a utilização de modificadores de risco, como o score de cálcio coronário (ScCa). O objetivo deste trabalho foi avaliar o custo-efetividade (CE) de três estratégias de diagnóstico de DAC nesta população: (A) não testar; (B) realizar ScCa, evitando exames adicionais se ScCa=0, e procedendo a angiotomografia computorizada (angioTC) coronária se ScCa>0; (C) angioTC como primeira linha.
Desenvolvemos um modelo de CE com base num estudo transversal em dois centros, incluindo 1385 doentes com dor torácica estável e PPT<15% submetidos a ScCa seguido de angioTC coronária. As principais variáveis incluíram a prevalência de DAC obstrutiva na angioTC (10,3%), a proporção com ScCa=0 (57%) e o valor preditivo negativo do ScCa para DAC obstrutiva na angioTC (98,1%).
Não testar diagnosticaria corretamente 89,7% dos casos, a um custo de €121.433 por 1.000 doentes. Usar o ScCa como gatekeeper permitiria classificar corretamente 98,9% e custaria €247.116/1.000 doentes. A angioTC como primeira linha diagnosticaria todos os doentes, a um custo de €271.007/1.000 doentes. O custo de um diagnóstico correto adicional foi de €1.366 para ScCa±angioTC versus não testar e €2.172 para angioTC versus ScCa±angioTC.
A estratégia usando ScCa como gatekeeper é custo-efetiva entre um limiar de €1.366 e €2.172 por diagnóstico correto adicional. A angioTC coronária produz a maior taxa de diagnósticos corretos e é custo-efetiva acima de um limiar de €2.172.</abstract><cop>Portugal</cop><pub>Elsevier España, S.L.U</pub><pmid>36958569</pmid><doi>10.1016/j.repc.2023.03.005</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0870-2551 |
| ispartof | Revista portuguesa de cardiologia, 2023-07, Vol.42 (7), p.617-624 |
| issn | 0870-2551 2174-2030 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2791373277 |
| source | Directory of Open Access Journals - May need to register for free articles; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Angiotomografia computorizada cardíaca Coronary artery calcium score Coronary artery disease Coronary CT angiography Cost-effectiveness Custo-efetividade Diagnosis Diagnóstico Doença arterial coronária Score de cálcio coronário |
| title | Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis |
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