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

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.