Noninvasive imaging for the diagnosis of coronary artery disease: Focusing the development of new diagnostic technology

Maria G M Hunink, Karen M. Kuntz, Kirsten E. Fleischmann, Thomas J. Brady, Barbara Hudson

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Background: New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease. Objective: To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests. Design: Decision model and cost-effectiveness analysis. Data Sources: Literature review and meta-analysis. Target Population: 55-year-old men and 65-year-old women presenting with chest pain. Time Horizon: Lifetime of the patient. Perspective: Health care policy. Interventions: MRI, electron-beam CT, exercise echocardiography, exercise single-photon emission CT, and coronary angiography. Outcome Measures: Target sensitivity and specificity values for a new noninvasive test. Results of Base-Case Analysis: Assuming that society is willing to pay $75 000 per quality-adjusted life-year (QALY) gained, a new test that costs $1000 would need a sensitivity of 94% and a specificity of 90% to be cost-effective. Results of Sensitivity Analysis: Assuming that society is willing to pay $50 000 per QALY gained, a new test that costs $1000 or more would never be cost-effective. For a test that costs $500, the sensitivity and specificity must each be 95%. Conclusions: New imaging techniques, such as MRI and electron-beam CT, must be relatively inexpensive and have excellent sensitivity and specificity to be cost- effective compared with other techniques for the diagnosis of coronary artery disease. Similar analyses in other areas of health care may help to focus the development of new diagnostic technology.

Original languageEnglish (US)
Pages (from-to)673-680
Number of pages8
JournalAnnals of internal medicine
Volume131
Issue number9
DOIs
StatePublished - Nov 2 1999

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