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Cost-Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain

Joseph A. Ladapo1, Udo Hoffmann2,3, Fabian Bamberg2, John T. Nagurney4, David M. Cutler5,6, Milton C. Weinstein7 and G. Scott Gazelle2,3,7,8

1 Harvard Ph.D. Program in Health Policy, 14 Story St., 4th Floor, Cambridge, MA 02138.
2 Department of Radiology, Massachusetts General Hospital, Boston, MA.
3 Harvard Medical School, Boston, MA.
4 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
5 Department of Economics, Harvard University, Cambridge, MA.
6 National Bureau of Economic Research, Cambridge, MA.
7 Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
8 Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.


Figure 1
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  		Fig. 1 —Decision pathway for patients with low-risk chest pain presenting to emergency department and managed under standard-of-care algorithm. CABG = coronary artery bypass graft, Cath + = coronary catheterization reveals significant stenosis, Cath – = coronary catheterization reveals mild or no stenosis, LM = left main artery disease, n-v = n-vessel disease, PCI = percutaneous coronary intervention, Trop/Stress test + = troponin elevated or stress test positive for ischemia, Trop/Stress test – = troponin normal and stress test negative for ischemia.

 

Figure 2
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  		Fig. 2 —Decision pathway for patients with low-risk chest pain presenting to emergency department and managed under CT coronary angiography algorithm. CABG = coronary artery bypass graft, Cath + = coronary catheterization reveals significant stenosis, Cath – = coronary catheterization reveals mild or no stenosis, CTCA ++ = CT coronary angiography positive for significant stenosis, CTCA + = CT coronary angiography positive for mild stenosis, CTCA – = CT coronary angiography negative for any atherosclerosis, LM = left main artery disease, n-v = n-vessel disease, PCI = percutaneous coronary intervention, Trop/Stress test + = troponin elevated or stress test positive for ischemia, Trop/Stress test – = troponin normal and stress test negative for ischemia.

 

Figure 3
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  		Fig. 3 —Health states for patients with chest pain. CAD = coronary artery disease.

 

Figure 4
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  		Fig. 4 —Incremental cost-effectiveness of CT coronary angiography (CTCA) management at varying examination costs for men (solid line) and women (dashed line). QALY = quality-adjusted life year.

 

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