Cost effectiveness of stress only gated myocardial perfusion SPECT following normal stress scintigraphy findings

摘要

In Australia, approximately 70000 myocardial perfusion SPECT studies are performed annually, costing in excess of $51 million. Eliminating the rest study in the presence of a normal stress study may potentially save millions of dollars annually.Methodology: This study was a retrospective cost effectiveness analysis that examined the potential of eliminating the rest study when the initial gated stress study is normal in both perfusion and function. Decision tree analysis was performed to determine the cost effectiveness of this approach compared to the more traditional rest and stress procedure.Results: 100% (174/174) of normal stress studies were associated with a normal rest study. Decision tree analysis demonstrated a potential saving of $3600000 annually without compromising patient management or outcomes. Conclusion: Eliminating the rest image when the initial stress image is normal in both perfusion and function provides a positive cost benefit relationship without risking diagnostic integrity of the procedure. Additionally, eliminating the rest study reduces radiation exposure, reduces the time commitment of patients and potentially reduces waiting lists in busy department; increasing marginal profits. Introduction The rise in health care expenditure in Australia has seen the evolution of economic rationalism in health. While gated myocardial perfusion single photon emission computed tomography (SPECT) offers the benefit of both perfusion and functional assessment, it remains an expensive procedure. Cost effectiveness analysis is an analytical approach that integrates a tests economic value with its clinical effectiveness (1). The calculation of marginal or incremental cost effectiveness provides a rational means to balance health care quality and clinical value in terms of best outcomes at a reasonable cost (1). In this manner a cost effectiveness analysis relates the economic resources consumed in relation to the benefits attained (1). Myocardial perfusion studies are the most commonly performed cardiac examination in clinical nuclear medicine practice. In Australia, approximately 700000 myocardial perfusion studies are performed annually (2). Demonstration of normal perfusion and function in a stress study may eliminate the need for a corresponding rest study. Guerra et al. (3), Schroeder-Tanka et al. (4), Snapper et al. (5) and Worsley (6) have each investigated the use of stress only myocardial perfusion SPECT. None of these studies examined the potential economic benefits of this policy. Each demonstrated that a normal stress myocardial perfusion study corresponded to a normal rest study in 100% of patients (table 1) (3,4,5,6). This might be largely attributed to the use of 99m Tc based radiopharmaceuticals where, in contrast to 201 Tl thallous chloride, reverse redistribution offers no diagnostic or prognostic value.