Copyright © 1999 by the European Society of Cardiology.
Economics of Myocardial Perfusion Imaging in Europe—the EMPIRE study
a National Heart and Lung Institute, Imperial College School of Medicine, London, U.K.
b Arthur D. Little Ltd, London, U.K.
c Amersham, U.K.
d Institute of Nuclear Medicine, University College London School of Medicine, London, U.K.
accepted July 1, 1998
Abstract
Background
Physicians use myocardial perfusion imaging to a variable extent in patients presenting with possible coronary artery disease. There are few clinical data on the most cost-effective strategy although computer models predict that routine use of myocardial perfusion imaging is cost-effective.
Objectives
To measure the cost-effectiveness of four diagnostic strategies in patients newly presenting with possible coronary artery disease, and to compare cost-effectiveness in centres that routinely use myocardial perfusion imaging with those that do not.
Methods
We have studied 396 patients presenting to eight hospitals for the diagnosis of coronary artery disease. The hospitals were regular users or non-users of myocardial perfusion imaging with one of each in four countries (France, Germany, Italy, United Kingdom). Information was gathered retrospectively on presentation, investigations, complications, and clinical management, and patients were followed-up for 2 years in order to assess outcome. Pre- and post-test probabilities of coronary artery disease were computed for diagnostic tests and each test was also assigned as diagnostic or part of management. Diagnostic strategies defined were: 1: Exercise electrocardiogram/coronary angiography, 2: exercise electrocardiogram/myocardial perfusion imaging/coronary angiography, 3: myocardial perfusion imaging/coronary angiography, 4: coronary angiography. Primary outcome measures were the cost and accuracy of diagnosis, the cost of subsequent management, and clinical outcome. Secondary measures included prognostic power, normal angiography rate, and rate of angiography not followed by revascularization.
Results
Mean diagnostic costs per patient were: strategy 1: £490, 2: £409, 3: £460, 4: £1253 (P<0·0001). Myocardial perfusion imaging users: £529, non-users £667 (P=0·006). Mean probability of the presence of coronary artery disease when the final clinical diagnosis was coronary artery disease present were, strategy 1: 0·85, 2: 0·82, 3: 0·97, 4: 1·0 (P<0·0001), users 0·93, non-users 0·88 (P=0·02), and when coronary artery disease was absent, 1: 0·26, 2: 0·22, 3: 0·16, 4: 0·0 (P<0·0001), users 0·21, non-users 0·20 (P=ns). Total 2-year costs (coronary artery disease present/absent) were: strategy 1: £4453/£710, 2: £3842/£478, 3: £3768/£574, 4: £5599/£1475 (P<0·05/0·0001), users: £5563/£623, non-users: £5428/£916 (P=ns/0·001). Prognostic power at diagnosis was higher (P<0·0001) and normal coronary angiography rate lower (P=0·07) in the scintigraphic centres and strategies. Numbers of soft and hard cardiac events over 2 years and final symptomatic status did not differ between strategy or centre.
Conclusion
Investigative strategies using myocardial perfusion imaging are cheaper and equally effective when compared with strategies that do not use myocardial perfusion imaging, both for cost of diagnosis and for overall 2 year management costs. Two year patient outcome is the same.
Key Words: Cost-effectiveness • economics • myocardial perfusion scintigraphy • coronary artery disease • diagnosis
1 Correspondence: Professor S. R. Underwood, Royal Brompton Hospital, Sydney Street, London SW3 6NP, U.K.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Marcassa, J. J. Bax, F. Bengel, B. Hesse, C. L. Petersen, E. Reyes, R. Underwood, and on behalf of the European Council of Nuclear Cardi Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement Eur. Heart J., February 2, 2008; 29(4): 557 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Hernandez and L. Vale The Value of Myocardial Perfusion Scintigraphy in the Diagnosis and Management of Angina and Myocardial Infarction: A Probabilistic Economic Analysis Med Decis Making, December 1, 2007; 27(6): 772 - 788. [Abstract] [PDF]
|
|
|
|
|
|
M. Dewey, H.-P. Dubel, T. Schink, G. Baumann, and B. Hamm Head-to-head comparison of multislice computed tomography and exercise electrocardiography for diagnosis of coronary artery disease Eur. Heart J., October 2, 2007; 28(20): 2485 - 2490. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, T. H. Marwick, D. S. Berman, S. Sawada, G. V. Heller, C. Vasey, and D. D. Miller Incremental cost-effectiveness of exercise echocardiography vs. SPECT imaging for the evaluation of stable chest pain Eur. Heart J., October 2, 2006; 27(20): 2448 - 2458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. V. Anand, E. Lim, A. Lahiri, and J. J. Bax The role of non-invasive imaging in the risk stratification of asymptomatic diabetic subjects Eur. Heart J., April 2, 2006; 27(8): 905 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Funk, D. L. Kirch, J. E. Koss, E. Botvinick, and B. H. Hasegawa A Novel Approach to Multipinhole SPECT for Myocardial Perfusion Imaging J. Nucl. Med., April 1, 2006; 47(4): 595 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Reyes and S. R. Underwood Myocardial perfusion scintigraphy: an important step between clinical assessment and coronary angiography in patients with stable chest pain Eur. Heart J., January 1, 2006; 27(1): 3 - 4. [Full Text] [PDF]
|
|
|
|
|
|
P. F. Hoilund-Carlsen, A. Johansen, H. W. Christensen, W. Vach, M. Moldrup, P. Bartram, A. Veje, T. Haghfelt, and for the Myocardial Ischemia Logistics Evaluation S Potential impact of myocardial perfusion scintigraphy as gatekeeper for invasive examination and treatment in patients with stable angina pectoris: observational study without post-test referral bias Eur. Heart J., January 1, 2006; 27(1): 29 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Prepared jointly by the British Cardiac Society, t Setting up a myocardial perfusion scintigraphy service: clinical and business aspects Heart, September 1, 2005; 91(suppl_4): iv6 - iv14. [Full Text] [PDF]
|
|
|
|
 |
|
 S. K Prasad, R. G Assomull, and D. J Pennell Recent developments in non-invasive cardiology BMJ, December 11, 2004; 329(7479): 1386 - 1389. [Full Text] [PDF]
|
|
|
|
|
|
J E Udelson and E J Flint Radionuclide imaging in risk assessment after acute coronary syndromes Heart, August 1, 2004; 90(suppl_5): v16 - v25. [Full Text] [PDF]
|
|
|
|
|
|
S R Underwood and L J Shaw Myocardial perfusion scintigraphy and cost effectiveness of diagnosis and management of coronary heart disease Heart, August 1, 2004; 90(suppl_5): v34 - v36. [Full Text] [PDF]
|
|
|
|
|
|
S L Rahman and A D Kelion Nuclear cardiology in the UK: do we apply evidence based medicine? Heart, August 1, 2004; 90(suppl_5): v37 - v40. [Full Text] [PDF]
|
|
|
|
|
|
N K Sabharwal and A Lahiri Role of myocardial perfusion imaging for risk stratification in suspected or known coronary artery disease Heart, November 1, 2003; 89(11): 1291 - 1297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T.H. Marwick, L. Shaw, C. Case, C. Vasey, and J.D. Thomas Clinical and economic impact of exercise electrocardiography and exercise echocardiography in clinical practice Eur. Heart J., June 2, 2003; 24(12): 1153 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, R. Hendel, S. Borges-Neto, M. S. Lauer, N. Alazraki, J. Burnette, E. Krawczynska, M. Cerqueira, and J. Maddahi Prognostic Value of Normal Exercise and Adenosine 99mTc-Tetrofosmin SPECT Imaging: Results from the Multicenter Registry of 4,728 Patients J. Nucl. Med., February 1, 2003; 44(2): 134 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Anagnostopoulos, M Y Henein, and S R Underwood Non-invasive investigations: Ischaemic heart disease Br. Med. Bull., October 1, 2001; 59(1): 29 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Anagnostopoulos and S R Underwood Cardiac imaging Imaging, September 1, 2001; 13(3): 155 - 163. [Abstract] [Full Text] [PDF]
|
|