Clinical and economic outcomes assessment in nuclear cardiology

The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical in formation at similar or lower comparative costs. with an ever-increasing em phasis on cost containment, outcome assessment forms the basis of preservin g the duality of patient cafe. Today, outcomes assessment encompasses a wid e array of subjects including clinical economic, and humanistic (i.e., qual ity of life) outcomes. For nuclear cardiology evidence-based medicine mould require a threshold level of evidence in order to justify the added cost o f any test in a patient's work-up. This evidence would include large multic enter, observational series as well as randomized trial data in sufficientl y large and diverse patient populations. The nem movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, me have seen a dramatic shift in the quality of outcomes data published in nuclear cardiology This includes the use of statistically rigorous risk-adjusted t echniques as well as large populations (i.e., >500 patients) representing m ultiple diverse medical care settings, This has been the direct result of t he development of multiple outcomes databases that have now amassed thousan ds of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combine d endpoints (e.g., death, myocardial infarction, or unstable angina), New t echnologies for the diagnosis of coronary artery disease have contributed t o the rising costs of care. In the United States and in Europe, costs of ca re have risen dramatically, consuming an ever-increasing amount of availabl e resources. The overuse of diagnostic angiography often leads to unnecessa ry revascularization that does not lead to improvement in outcome. Thus, th e potential exists that stress SPECT imaging, a highly effective diagnostic tool, could effect substantial change in reducing inappropriate use of an invasive procedure resulting in cost effective cardiac care. A synthesis of current economic evidence in gated SPECT imaging will be presented In conc lusion, a current state of the evidence review is presented on the clinical and economic data using nuclear cardiology imaging.