naa a22 4500 510747906 CHVBK 20180411083053.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s11547-013-0933-z doi (NATIONALLICENCE)springer-10.1007/s11547-013-0933-z Role of MDCT coronary angiography in the clinical setting: economic implications [Elektronische Daten] [Roberto Malagò, Andrea Pezzato, Camilla Barbiani, Domenico Tavella, Paola Vallerio, Anna Pasini, Luciano Cominacini, Roberto Mucelli] Ruolo dell'angiografia coronarica TCMS nella pratica clinica: implicazioni economiche Purpose: This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup. Material and methods: Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary). Results: Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol. Conclusions: The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile. Springer-Verlag, 2013 MDCT coronary angiography nationallicence Stress test nationallicence Coronary angiography nationallicence Cost analysis nationallicence Atypical chest pain nationallicence Angiografia coronarica mediante TCMS stress test nationallicence Coronarografia nationallicence Analisi dei costi nationallicence Dolore toracico atipico nationallicence Malagò Roberto Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut Pezzato Andrea Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut Barbiani Camilla Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut Tavella Domenico U.O. Cardiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut Vallerio Paola U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut Pasini Anna U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut Cominacini Luciano U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut Mucelli Roberto Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut La radiologia medica Springer-Verlag 118/8(2013-12-01), 1294-1308 0033-8362 118:8<1294 2013 118 11547 https://doi.org/10.1007/s11547-013-0933-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11547-013-0933-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Malagò Roberto Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut NATIONALLICENCE 700 1- Pezzato Andrea Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut NATIONALLICENCE 700 1- Barbiani Camilla Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut NATIONALLICENCE 700 1- Tavella Domenico U.O. Cardiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut NATIONALLICENCE 700 1- Vallerio Paola U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut NATIONALLICENCE 700 1- Pasini Anna U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut NATIONALLICENCE 700 1- Cominacini Luciano U.O.C. di Medicina Interna, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, Verona, Italy aut NATIONALLICENCE 700 1- Mucelli Roberto Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy aut NATIONALLICENCE 773 0- La radiologia medica Springer-Verlag 118/8(2013-12-01), 1294-1308 0033-8362 118:8<1294 2013 118 11547 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer