A large population-based study of over 2 million people evaluated for chest pain shows noninvasive cardiac imaging led to a reduction in downstream costs when compared to no testing. Additionally, stress test echocardiography was associated with the lowest downstream cost, signaling the effectiveness of the test in identifying serious issues of the heart. The results are published in the Journal of the American Society of Echocardiography. [1]
Researchers from various academic institutions looked at the cost of noninvasive tests for diagnosing serious illness, such as coronary artery disease. Using available population data on patients who presented with chest pain, the research team led by Idan Roifman, MD, of the University of Toronto compared the downstream costs of multiple noninvasive tests, including CCTA, myocardial perfusion imaging, dress echocardiogram, and exercise-based cardiac stress testing.
“Non-invasive cardiac diagnostic tests for the diagnosis of coronary artery disease have been estimated to cost > $3 billion annually in the United States alone and have undergone recent scrutiny over concerns of overuse. Consequently, comparing costs of different non-invasive cardiac diagnostic testing strategies is of urgent importance to healthcare planning,” Roifman and the other authors wrote.
Of their sample data set of 2,340,699 Canadian patients, the researchers examined data from 481,170 patients who received a noninvasive cardiac test. Of the total, 254,492 individuals (53%) underwent an exercise stress test; 154,137 (32%) underwent myocardial perfusion imaging; 69,160 (14%) underwent a stress echocardiogram, and 3,381 (< 1%) underwent a CCTA exam.
The researchers discovered that, even after adjusting for variances in baseline patient characteristics and considering the additional cost of the initial tests, undergoing any of these tests was associated with a 12% reduction in downstream one-year average costs. This was reflected in a cost ratio of 0.88 compared to patients without any testing
The study authors then conducted a comparison of each testing strategy with no testing. The findings indicated that stress echocardiography and exercise stress testing resulted in lower downstream costs, with cost ratios of 0.82 and 0.8, respectively. In contrast, myocardial perfusion imaging had a cost ratio of 1.26, and CCTA had a cost ratio of 1.29, signifying higher downstream costs.
At what looks to be an 18% cost savings downstream, stress echocardiograms looks to be the least expensive noninvasive diagnostic procedure for patients with chest pain. The authors also note that many health systems in the U.S. do not require pre-approval from payers for a patient to undergo the test, making it a more widely available option.
The authors added that more research is needed to confirm their results, as the dataset used for this study was limited to health systems in Canada, where administrative costs differ from the U.S.
The full study can be found here.
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