Diagnostische Herzkatheteruntersuchung

Hamm, Christian W.; Albrecht, Alexander; Bonzel, T.; Kelm, Malte; Lange, H J; Schächinger, Volker; Terres, Wolfram; Voelker, Wolfram

doi:10.1007/s00392-008-0686-1

Cited by 29 publications

(9 citation statements)

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“…Cost associated with complications caused by diagnostic CATH. We assumed that the rate of major iatrogenic adverse cardiovascular events (death, myocardial infarction, or stroke) was 0.05% 18 , while that of vascular access-related complications that required transfusion or surgery was 0.4% (for a rate of 80% for radial access use) 19 . With regard to major cardiovascular events, we considered acute myocardial infarction to be a typical complication 3,20 and estimated its cost by adding the cost for a homogeneous diagnostic group (HDG) of patients with nonfatal myocardial infarction without major complications (€3,671.53) 15 to the cost of 1 month of temporary incapacity to work, for a gross domestic product (GDP) per capita of €16,100, assuming that half of the population assessed for suspected CAD was active.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

Ferreira¹,

Marques²,

Gonçalves³

et al. 2014

Arquivos Brasileiros De Cardiologia

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BackgroundCost-effectiveness is an increasingly important factor in the choice of a test or therapy.ObjectiveTo assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal.MethodsSeven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%.ResultsThe cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy.ConclusionsDiagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.

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Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

Ferreira¹,

Marques²,

Gonçalves³

et al. 2014

Arquivos Brasileiros De Cardiologia

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“…zero bleeding complications. A time horizon of 24 h is chosen in accordance with published studies and expert opinion, which covers the time from sheath removal to cure of all complications and hospital discharge [ 22 , 23 , 30 , 31 ].…”

Section: Methodsmentioning

confidence: 99%

Early decision-analytic modeling – a case study on vascular closure devices

Brandes

Sinner

Kääb

et al. 2015

BMC Health Serv Res

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BackgroundAs economic considerations become more important in healthcare reimbursement, decisions about the further development of medical innovations need to take into account not only medical need and potential clinical effectiveness, but also cost-effectiveness. Already early in the innovation process economic evaluations can support decisions on development in specific indications or patient groups by anticipating future reimbursement and implementation decisions. One potential concept for early assessment is value-based pricing.MethodsThe objective is to assess the feasibility of value-based pricing and product design for a hypothetical vascular closure device in the pre-clinical stage which aims at decreasing bleeding events. A deterministic decision-analytic model was developed to estimate the cost-effectiveness of established vascular closure devices from the perspective of the Statutory Health Insurance system. To identify early benchmarks for pricing and product design, three strategies of determining the product’s value are explored: 1) savings from complications avoided by the new device; 2) valuation of the avoided complications based on an assumed willingness-to-pay-threshold (the efficiency frontier approach); 3) value associated with modifying the care pathways within which the device would be applied.ResultsUse of established vascular closure devices is dominated by manual compression. The hypothetical vascular closure device reduces overall complication rates at higher costs than manual compression. Maximum cost savings of only about €4 per catheterization could be realized by applying the hypothetical device. Extrapolation of an efficiency frontier is only possible for one subgroup where vascular closure devices are not a dominated strategy. Modifying care in terms of same-day discharge of patients treated with vascular closure devices could result in cost savings of €400-600 per catheterization.ConclusionsIt was partially feasible to calculate value-based prices for the novel closure device which can be used to inform product design. However, modifying the care pathway may generate much more value from the payers’ perspective than modifying the device per se. Manufacturers should thus explore the feasibility of combining reimbursement of their product with arrangements that make same-day discharge attractive also for hospitals. Due to the early nature of the product, the results are afflicted with substantial uncertainty.

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“…By definition, invasive angiography represented a perfect diagnostic test (i.e., 100% sensitive and 100% specific) without any non-diagnostic results [19-21]. The rates of complication and mortality for patients undergoing invasive coronary angiography were derived from the literature [28]. …”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany

Boldt

Leber

Bonaventura

et al. 2013

Journal of Cardiovascular Magnetic Resonance

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BackgroundRecent studies have demonstrated a superior diagnostic accuracy of cardiovascular magnetic resonance (CMR) for the detection of coronary artery disease (CAD). We aimed to determine the comparative cost-effectiveness of CMR versus single-photon emission computed tomography (SPECT).MethodsBased on Bayes’ theorem, a mathematical model was developed to compare the cost-effectiveness and utility of CMR with SPECT in patients with suspected CAD. Invasive coronary angiography served as the standard of reference. Effectiveness was defined as the accurate detection of CAD, and utility as the number of quality-adjusted life-years (QALYs) gained. Model input parameters were derived from the literature, and the cost analysis was conducted from a German health care payer’s perspective. Extensive sensitivity analyses were performed.ResultsReimbursement fees represented only a minor fraction of the total costs incurred by a diagnostic strategy. Increases in the prevalence of CAD were generally associated with improved cost-effectiveness and decreased costs per utility unit (ΔQALY). By comparison, CMR was consistently more cost-effective than SPECT, and showed lower costs per QALY gained. Given a CAD prevalence of 0.50, CMR was associated with total costs of €6,120 for one patient correctly diagnosed as having CAD and with €2,246 per ΔQALY gained versus €7,065 and €2,931 for SPECT, respectively. Above a threshold value of CAD prevalence of 0.60, proceeding directly to invasive angiography was the most cost-effective approach.ConclusionsIn patients with low to intermediate CAD probabilities, CMR is more cost-effective than SPECT. Moreover, lower costs per utility unit indicate a superior clinical utility of CMR.

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Diagnostische Herzkatheteruntersuchung

Cited by 29 publications

References 0 publications

Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

Early decision-analytic modeling – a case study on vascular closure devices

Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany

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