Cost-effectiveness of Routine Coronary Angiography After Acute Myocardial Infarction

Kuntz, Karen M.; Tsevat, Joel; Goldman, Lee; Weinstein, Milton C.

doi:10.1161/01.cir.94.5.957

Cited by 106 publications

(49 citation statements)

References 51 publications

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“…Our findings are also in general agreement with the cost-effectiveness model of Kuntz et al, 21 who found that coronary angiography was highly cost-effective in patients with postinfarction angina and a strongly positive exercise test, criteria for angiography similar to those of our conservative, ischemia-guided management strategy. By contrast, their model found that angiography was not cost-effective in the absence of postinfarction angina or a positive exercise test.…”

Section: Cost-effectivenesssupporting

confidence: 91%

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Cost-Effectiveness of a Conservative, Ischemia-Guided Management Strategy After Non–Q-Wave Myocardial Infarction

et al. 2002

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Background-Use of coronary angiography after myocardial infarction has been controversial, with some physicians advocating routine use and others advocating selective use only after documentation of residual myocardial ischemia. The effects of these strategies on economic outcomes have not been established. Methods and Results-We analyzed data from a randomized, controlled clinical trial conducted in 17 Department of Veterans Affairs hospitals that enrolled 876 clinically uncomplicated patients 24 to 72 hours after an acute non-Q-wave myocardial infarction. The routine invasive strategy included early coronary angiography with revascularization based on established guidelines. The conservative, ischemia-guided strategy included noninvasive testing with radionuclide ventriculography and exercise thallium scintigraphy, followed by coronary angiography in patients with objective evidence of myocardial ischemia. We measured the cost of hospitalization and outpatient visits and tests during follow-up and calculated the incremental cost-effectiveness ratio. The conservative, ischemia-guided strategy had lower costs than the routine invasive strategy, both during the initial hospitalization ($14 733 versus $19 256, PϽ0.001) and after a mean follow-up of 1.9 years ($39 707 versus $41 893, Pϭ0.04). The hazard ratio for death was 0.72 (confidence limits, 0.51 to 1.01) in the conservative strategy. The conservative strategy had lower costs and better outcomes in 76% of 1000 bootstrap replications, and a cost-effectiveness ratio below $50 000 per year of life added in 96% of replications. Conclusions-A conservative, ischemia-guided strategy of selective coronary angiography and revascularization for patients who develop objective evidence of recurrent ischemia is more cost-effective than a strategy of routine coronary angiography after uncomplicated non-Q-wave myocardial infarction. (Circulation. 2002;105:680-684.)

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Section: Cost-effectivenesssupporting

confidence: 91%

“…By contrast, their model found that angiography was not cost-effective in the absence of postinfarction angina or a positive exercise test. 21 Although different in design, the model of Kuntz et al 21 agrees with our finding that a selective approach to coronary angiography after myocardial infarction is more cost-effective.…”

Section: Cost-effectivenesssupporting

confidence: 77%

Cost-Effectiveness of a Conservative, Ischemia-Guided Management Strategy After Non–Q-Wave Myocardial Infarction

et al. 2002

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“…Laupacis et al 16 suggested that interventions with an icer of less than $20,000/qaly are cost-effective and those with an icer of more than $100,000/qaly are not costeffective; however, those figures are based on 1992 dollars. A few influential and widely cited articles use $50,000/qaly as the threshold 17,18 . In a recent survey of oncologists in both Canada and the United States, 49%-56% of respondents thought that a reasonable cost-effectiveness ratio was $50,000 to $100,000 per 30,604 --icer = incremental cost-effectiveness ratio; gem = gemcitabine; cap = capecitabine; e = erlotinib; folfirinox = 5-fluorouracil-leucovorinirinotecan-oxaliplatin; qalys = quality-adjusted life years.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer

Tam

Mittmann

et al. 2013

Current Oncology

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“…Kuntz et al (39), using a decision analysis, assessed the cost-effectiveness of coronary angiography to identify candidates for revascularization after acute myocardial infarction (AMI). Data on effectiveness were based on randomized trials comparing CABG with medical therapy, since there had been no completed trials involving PTCA at the time.…”

Section: Coronary Heart Diseasementioning

confidence: 99%

“…The number of LYs was the metric of health outcome used in all the primary and secondary prevention CEAs (17,24,29,66). The analyses of tertiary prevention measures were more likely to use QALYs (29,39,45). Quality weights were likely to be based on physician or patient (rather than community) preferences (77).…”

Section: Coronary Heart Diseasementioning

confidence: 99%

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

Graham

Corso

Morris

et al. 1998

Annu. Rev. Public Health

Self Cite

133

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Cost-effectiveness analysis, an analytic tool that expresses as a ratio the cost of obtaining an additional unit of health outcome, can help decision makers achieve more health protection for the same or less cost. We characterize the state of the cost-effectiveness analysis literature by reviewing how this technique is applied to various clinical and public health interventions. We describe the results of cost-effectiveness analyses for over 40 interventions to reduce cancer, heart disease, trauma, and infectious disease. The cost-effectiveness ratios for these interventions vary enormously, from interventions that save money to those that cost more than $1 million per year of life gained. The methods used to derive the cost-effectiveness ratios also vary considerably, and we summarize this variation within each health area. Greater uniformity of analytical practice will be necessary if cost-effectiveness analysis is to become a more influential tool in debates about resource allocation.

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Cost-effectiveness of Routine Coronary Angiography After Acute Myocardial Infarction

Abstract: In many patient subgroups after AMI, the cost-effectiveness of routine coronary angiography and treatment guided by its results compares favorably with other treatment strategies for coronary heart disease.

Cited by 106 publications

References 51 publications

Cost-Effectiveness of a Conservative, Ischemia-Guided Management Strategy After Non–Q-Wave Myocardial Infarction

Cost-Effectiveness of a Conservative, Ischemia-Guided Management Strategy After Non–Q-Wave Myocardial Infarction

Cost-Effectiveness of Systemic Therapies for Metastatic Pancreatic Cancer

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

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