COST-EFFECTIVENESS ANALYSIS IN DIAGNOSIS OF CARDIAC DISEASE - OVERVIEW OF ITS RATIONALE AND METHOD

This article reviews selected literature that can be useful for analys is of cost-effectiveness (CE) of diagnostic procedures in patients wit h known or suspected coronary artery disease. First, a clinical exampl e illustrates some of the issues involved. Four questions are used to organize the material: (1) What is CE analysis? (2) Why should we use CE analysis? (3) Who should perform CE analysis? and (4) How should CE analysis be performed? (1) What is CE analysis? CE analysis differs f rom cost-reduction or cost-benefit analysis but may encompass cost-uti lity analysis. Marginal CE emphasizes differences in CE between differ ent strategies. (2) Why should we use CF analysis? Nuclear cardiology depends on the fruits of medical technology, and many policy makers bl ame technology for escalating costs of health care. This situation req uires us to reduce the absolute cost or the increment in cost, as well as to assess the true value of the technology we use. (3) Who should perform CE analysis? A team approach is the best answer to combine the expertise from clinicians and economists. A team approach and detaile d definitions of assumptions can help minimize potential bias. (4) How should CE analysis be performed? CE analysis requires formulating imp ortant questions, designing alternative scenarios or strategies, selec ting values for the numeric variables and including the probability th at an event will occur, calculating cost per outcome, and sensitivity analysis of the model. The appropriate goal of CE analysis of the clin ical use of cardiac imaging procedures is, first, to help improve pati ent outcome and, second, to limit costs.