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64-Slice CT coronary angiography versus conventional coronary angiography: activity-based cost analysis

Coronarografia versus coronaro-TC: analisi dei costi

  • Cardioradiology/Cardioradiologia
  • Published:
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Abstract

Purpose

This study was done to analyse the costs of 64-slice computed tomography (CT) coronary angiography and conventional coronary angiography and determine the costeffectiveness of the two modalities.

Materials and methods

Detailed activity-based cost analyses of the two modalities were carried out at the departments of radiology and cardiology of a teaching hospital. The differential costs (equipment, variable, personnel), common costs and external costs were estimated. Finally, the full costs of the two procedures were obtained; the full cost of conventional coronary angiography also considered the cost of 1 day in hospital. The cost-effectiveness of the two procedures at different levels of pretest likelihood of coronary artery disease (CAD) was estimated.

Results

The costs of multidetector CT (MDCT) coronary angiography were as follows: differential cost 222.23 €, common cost 5.50 €, external cost 2.30 € and full cost 230.03 €. The costs of conventional coronary angiography were: differential cost 366.18 €, common cost 0.50 €, external cost 9.20 €, hospitalisation cost 1,652 € and full cost 2,027.88 €. Cost-effectiveness analysis showed that the cost per correctly identified CAD patient decreased exponentially with increasing pretest likelihoods of CAD. MDCT coronary angiography was more cost effective than conventional coronary angiography up to a pretest likelihood of 86%.

Conclusions

MDCT coronary angiography has far lower costs than conventional coronary angiography, and its costeffectiveness is better in the large majority of patients.

Riassunto

Obiettivo

Valutare i costi della coronaro-TC e della coronarografia ed analizzare il rapporto costo-efficacia delle due metodiche.

Materiali e metodi

Per ciascuna metodica è stata effettuata una dettagliata analisi dei costi all’interno della U.C.O. di Radiologia e della S.C. di Cardiologia. Sono stati calcolati i costi differenziali (costo apparecchiature, costi variabili, costo del personale medico, tecnico e infermieristico), i costi comuni e i costi esterni. Al costo della coronarografia è stato sommato il costo della giornata di degenza effettuata dopo tale procedura. E stato determinato il rapporto costo-efficacia delle due metodiche rapportandolo alle diverse categorie di probabilità pre-test di malattia coronarica.

Risultati

La coronaro-TC ha fatto registrare: costo differenziale € 222,23, costo comune € 5,50, costo esterno € 2,30, costo totale € 230,03. Per la coronarografia si è verificato: costo differenziale € 366,18, costo comune € 0,50, costo esterno € 9,20, costo degenza € 1652, costo totale € 2027,88. L’analisi di costo-efficacia ha dimostrato come il costo per identificare correttamente un paziente con malattia coronarica decresce notevolmente all’aumentare della probabilità pre-test. La coronaro-TC presenta un rapporto costoefficacia più favorevole rispetto alla coronarografia fino all’86% di probabilità pre-test.

Conclusioni

La coronaro-TC ha costi notevolmente inferiori alla coronarografia e un rapporto costo-efficacia migliore nella larga maggioranza dei pazienti.

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Authors and Affiliations

  1. Unità Clinica Operativa di Radiologia, Ospedale di Cattinara, Università degli Studi, Strada di Fiume 447, 34149, Trieste, Italy

    F. Stacul, D. Sironi, M. Belgrano & M. Cova

  2. Dipartimento di Economia Aziendale, Università degli Studi, Trieste, Italy

    G. Grisi

  3. Struttura Complessa di Cardiologia, Ospedale di Cattinara, Trieste, Italy

    A. Salvi

Authors
  1. F. Stacul
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  2. D. Sironi
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  3. G. Grisi
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  4. M. Belgrano
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  5. A. Salvi
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  6. M. Cova
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Correspondence to F. Stacul.

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Stacul, F., Sironi, D., Grisi, G. et al. 64-Slice CT coronary angiography versus conventional coronary angiography: activity-based cost analysis. Radiol med 114, 239–252 (2009). https://doi.org/10.1007/s11547-009-0376-8

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  • DOI: https://doi.org/10.1007/s11547-009-0376-8

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