Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country

Santos, Mauro Augusto dos; Santos, Marisa; Tura, Bernardo Rangel; Felix, R; Brito, Adriana Soares Xavier de; Lorenzo, Andrea De

doi:10.1007/s12350-016-0505-4

Cited by 13 publications

(18 citation statements)

References 29 publications

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“…In contrast, Gibbons et al reported a significant decrease in the proportion of inappropriate MPI scans performed in a single academic center after publications of the 2009 AUC 30. Furthermore, a recent budget impact analysis showed that application of the 2009 AUC could result in savings of 18.6% in a single tertiary care hospital in Brazil 31. To our knowledge, no studies have assessed the impact of the AUC on utilization rates of noninvasive cardiac diagnostic testing (including MPI) at the population level.…”

Section: Discussionmentioning

confidence: 96%

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Roifman

Austin

Qiu

et al. 2017

JAHA

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BackgroundConcern regarding overutilization of cardiac imaging has led to the development of appropriate use criteria (AUC). Myocardial perfusion imaging (MPI) is one of the most commonly used cardiac imaging modalities worldwide. Despite multiple iterations of AUC, there is currently no evidence regarding their real‐world impact on population‐based utilization rates of MPI. Our goal was to assess the impact of the AUC on rates of MPI in Ontario, Canada. We hypothesized that publication of the AUC would be associated with a significant reduction in MPI rates.Methods and ResultsWe conducted a retrospective cohort study of the adult population of Ontario from January 1, 2000, to December 31, 2015. Age‐ and sex‐standardized rates were compared from 4 different periods intersected by 3 published iterations of the AUC. Overall, 3 072 611 MPI scans were performed in Ontario during our study period. The mean monthly rate increased from 14.1/10 000 in the period from January 2000 to October 2005 to 18.2/10 000 between November 2005 and June 2009. After this point in time, there was a reduction in rates, falling to a mean monthly rate of 17.1/10 000 between March 2014 and December 2015. Time series analysis revealed that publication of the 2009 AUC was associated with a significant reduction in MPI rates (P<0.001). This translated into ≈88 849 fewer MPI scans at a cost savings of ≈72 million Canadian dollars.ConclusionsOur results reflect a potential real‐world impact of the 2009 MPI AUC by demonstrating evidence of a significant effect on population‐based rates of MPI.

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Section: Discussionmentioning

confidence: 96%

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Roifman

Austin

Qiu

et al. 2017

JAHA

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“…A recent study showed that SPECT MPI is widely used for diagnostic and risk stratification purposes in the United States and patient’s socio-economic status did not significantly affect the use of SPECT MPI by physicians[15]. In the developing world several studies have shown the widespread use of SPECT MPI by physicians to aid in diagnosis in management[16,17]. One such report from Iran regarding SPECT MPI referral practices showed that 72.5% (211/291) of the referrals found to be appropriate per ASNC recommendations[16].…”

Section: Discussionmentioning

confidence: 99%

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Malik

Abela

Devabhaktuni

et al. 2017

WJC

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AIMTo investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with non-dominant right coronary artery anatomy.METHODSThis was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain. Only patients who underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included. Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed. Patients with prior history of coronary artery disease (CAD) including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded. True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography, in the same territory as identified on SPECT MPI. Coronary artery dominance was determined on coronary angiography. Patients were divided into group 1 and group 2. Group 1 included patients with non-dominant right coronary artery (RCA) (left dominant and codominant). Group 2 included patients with dominant RCA anatomy. Demographics, baseline characteristics and positive predictive value (PPV) were analyzed for the two groups.RESULTSThe mean age of the study cohort was 57.6 years. Sixty-one point seven percent of the patients were males. The prevalence of self-reported diabetes mellitus, hypertension and dyslipidemia was 36%, 71.9% and 53.9% respectively. A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men. For inferior wall ischemia on SPECT MPI, patients in study group 2 had a significantly higher PPV, 32/42 (76.1%), compared to patients in group 1, in which only 3 out of the 29 patients (10.3%) had true positive results (P value < 0.001 Z test). The difference remained statistically significant even when only patients with left dominant coronary system (without co-dominant) were compared to patients with right dominant system (32/40, 76.1% in right dominant group, 3/19, 15.8% in left dominant group, P value < 0.001 Z test). There was no significant difference in mean hospital stay, re-hospitalization, and in-hospital mortality between the two groups.CONCLUSIONThe positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance. More studies are needed to explain this phenomenon.

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“…25 A significant body of literature demonstrated that appropriate MPI use enhances its acumen in risk stratification, reduces radiation risk, and improves its clinical value. [27][28][29][30][31][32][33] Physicians are faced with multiple, occasionally discordant, AUC from different organizations. For example, there is substantial discordance between the multimodality AUC for the detection and risk assessment of stable ischemic heart disease developed by the American College of Cardiology, ASNC, and several other societies and the Appropriateness Criteria set forth by the American College of Radiology (ACR).…”

Section: Appropriate Use Reportingmentioning

confidence: 99%

ASNC imaging guidelines for nuclear cardiology procedures

Tilkemeier

Bourque

Doukky

et al. 2017

Journal of Nuclear Cardiology

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Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country

Cited by 13 publications

References 29 publications

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

ASNC imaging guidelines for nuclear cardiology procedures

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