Cost-effectiveness of myocardial perfusion imaging: A summary of the currently available literature

Prez, Roger D. Des; Shaw, Leslee J.; Gillespie, Robert L.; Jaber, Wael A.; Noble, Gavin L; Soman, Prem; Wolinsky, David G.; Williams, Kim A.

doi:10.1016/j.nuclcard.2005.10.001

Cited by 56 publications

(44 citation statements)

References 46 publications

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“…Therefore, the economic consequences of inappropriate use of SPECT-MPI are significant, considering that ~5.8 million MPI studies are performed annually in the United States, nearly 85% of which are performed in the outpatient setting, 31,32 at a cost ranging from $800 to $1000 per study according to the 2013 Medicare reimbursement schedule. 33 Thus, although MPI is considered cost-effective overall, 34 the diminished prognostic value with inappropriate testing could have serious implications on the overall cost-effectiveness of MPI, not to mention unnecessary radiation exposure. In fact, minimizing inappropriate use is probably the best and most cost-efficient way to limit the radiation exposure in the community.…”

Section: Discussionmentioning

confidence: 99%

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

et al. 2013

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Background-Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown. Methods and Results-A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 27±10 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1; P=0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3; P=0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7; P=0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4; P<0.001). Among the 688 subjects (45.5%) with MPI classified as inappropriate, an abnormal MPI failed to predict major adverse cardiac events, although it was associated with a high revascularization rate. Furthermore, appropriate MPI use provided incremental prognostic value beyond myocardial perfusion and ejection fraction data. Conclusions-When performed for appropriate indications, SPECT-MPI continues to demonstrate high prognostic value.However, inappropriate use lacks effectiveness for risk stratification, further emphasizing the need for optimal patient selection for cardiac testing. (Circulation. 2013;128:1634-1643.)

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Section: Discussionmentioning

confidence: 99%

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

et al. 2013

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“…45, 46 It seems to be the most promising non-invasive imaging technique, given its high spatial resolution, lack of ionizing radiation, and good diagnostic accuracy and delineation between attenuation artifact and true myocardial infarcts or injuries. 47,48 divide into pre-arterioles located in the epicardial surface, with size ranging from 100 to 500 μm. 14 Finally, the prearterioles give rise to arterioles (<100 μm), which are intramyocardial and contribute to more than 50% of the total coronary vascular resistance.…”

Section: Cardiovascular Magnetic Resonance (Cmr)mentioning

confidence: 99%

Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

Chen

Wei

AlBadri

et al. 2017

Circ J

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Angina has traditionally been thought to be caused by obstructive coronary artery disease (CAD). However, a substantial number of patients with angina are found to not have obstructive CAD when undergoing coronary angiography. A significant proportion of these patients have coronary microvascular dysfunction (CMD), characterized by heightened sensitivity to vasoconstrictor stimuli and limited microvascular vasodilator capacity. With the advent of non-invasive and invasive techniques, the coronary microvasculature has been more extensively studied in the past 2 decades. CMD has been identified as a cause of cardiac ischemia, in addition to traditional atherosclerotic disease and vasospastic disease. CMD can occur alone or in the presence obstructive CAD. CMD shares many similar risk factors with macrovascular CAD. Diagnosis is achieved through detection of an attenuated response of coronary blood flow in response to vasodilatory agents. Imaging modalities such as cardiovascular magnetic resonance, positron emission tomography, and transthoracic Doppler echocardiography have become more widely used, but have not yet completely replaced the traditional intracoronary vasoreactivity testing. Treatment of CMD starts with lifestyle modification and risk factor control. The use of traditional antianginal, antiatherosclerotic medications and some novel agents may be beneficial; however, clinical trials are needed to assess the efficacy of the pharmacologic and non-pharmacologic therapeutic modalities. In addition, studies with longer-term follow-up are needed to determine the prognostic benefits of these agents. We review the epidemiology, prognosis, pathogenesis, diagnosis, risk factors and current therapies for CMD.

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“…Nuclear medicine studies may change medical management (4).ÁNuclear medicine studies have been shown to be cost-effective (5,6). For example, the Economics of Noninvasive Diagnosis study, a prospective study of 11,372 consecutive patients who had stable angina and were referred for stress myocardial perfusion tomography or cardiac catheterization, demonstrated that costs of care were higher for direct cardiac catheterization in all clinical risk subsets (range, $2,878-$4,579) than for stress myocardial perfusion imaging plus selective catheterization (range, $2,387-$3,010) (P , 0.0001) (7).…”

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confidence: 99%

Status of and Trends in Nuclear Medicine in the United States

Delbeke¹,

Segall²

2011

J Nucl Med

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Nuclear medicine in the United States has grown because of advances in technology, including hybrid imaging, the introduction of new radiopharmaceuticals for diagnosis and therapy, and the development of molecular imaging based on the tracer principle, which is not based on radioisotopes. Continued growth of the field will require cost-effectiveness data and evidence that nuclear medicine procedures affect patients' outcomes. Nuclear medicine physicians and radiologists will need more training in anatomic and molecular imaging. New educational models are being developed to ensure that future physicians will be adequately prepared.Key Words: nuclear medicine; statistics; status; trends J Nucl Med 2011; 52:24S-28S DOI: 10.2967/jnumed.110.085688Nucl ear medicine has a history of decades of strong growth, particularly in nuclear cardiology and PET/CT. In the United States, the number of nuclear medicine procedures has grown from approximately 14 million in 1999 to almost 20 million in 2005 (1). After 2005, however, it dropped to about 17 million. Most nuclear medicine procedures are performed in hospital-based settings, but the number performed in nonhospital settings has grown over time to one third of all nuclear medicine procedures in 2008.In the United States, the growth of nuclear medicine procedures is due primarily to nuclear cardiology, which has grown from about 7 million procedures in 1999 to about 11 million in 2005 (1). Nuclear cardiology represents more than 50% of the nuclear medicine procedures done in the United States but represents only 14% of those done in Europe. A study performed in 2007 investigated the worldwide use of nuclear cardiology (2). The study findings indicated that nuclear cardiology procedures were used most extensively in the United States, with 1,000 or more procedures performed per 100,000 people (Fig. 1).Bone scintigraphy is the next most common nuclear medicine procedure performed in the United States, but it represents only 17% of procedures (1). Bone scintigraphy represented 36% of procedures performed in Europe in 2008.The volume of PET procedures in the United States is approximately 1.5 million per year (3). Oncology accounts for more than 90% of the PET and PET/CT procedures performed, whereas cardiology and neurology account for about 4% each (3). According to the National Oncology PET Registry, about 84% of the slightly more than 1,600 PET facilities in the United States have PET/CT systems (4). The emergence of molecular imaging with new radiopharmaceuticals and new technologies is likely to result in continued growth in the coming decades.Efforts to control spiraling health care costs have resulted in decreased reimbursement for medical imaging and the need to provide evidence that patients' outcomes are improved by diagnostic tests and therapies. Radiology benefit managers have become gatekeepers for insurance plans, but without evidence to ensure the appropriate use of medical imaging, coverage decisions are frequently based on cost. Downward pressure on nuclear me...

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Cost-effectiveness of myocardial perfusion imaging: A summary of the currently available literature

Cited by 56 publications

References 46 publications

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

Status of and Trends in Nuclear Medicine in the United States

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Cost-effectiveness of myocardial perfusion imaging: A summary of the currently available literature

Cited by 56 publications

References 46 publications

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

Coronary Microvascular Dysfunction ― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

Status of and Trends in Nuclear Medicine in the United States

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Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―