Cost-effectiveness of myocardial perfusion SPECT and stress test according to coronary revascularization therapy, cardiac events and total mortality: Register of 8496 patients

Abstract Objective The aim was to analyze the cost-effectiveness ratio (CER) of stress electrocardiogram (ES) and stress myocardial perfusion imaging (SPECT-MPI) according to coronary revascularization (CR) therapy, cardiac events (CE) and total mortality (TM). Material and methods A total of 8496 consecutive patients who underwent SPECT-MPI were followed-up (mean 5.3 ± 3.5 years). Cost-effectiveness for coronary bypass (CABG) or percutaneous CR (PCR) (45.6%/54.4%) according to combined electrocardiographic ischemia and scintigraphic ischemia were evaluated. Effectiveness was evaluated as TM, CE, life-year saved observed (LYSO) and CE-LYSO; costs analyses were conducted from the perspective of the health care payer. A sensitivity analysis was performed considering current CABG/PCR ratios (12%/88%). Results When electrocardiogram and SPECT approaches are combined, the cost-effectiveness values for CABG ranged between 112,589 € (electrocardiographic and scintigraphic ischemia) and 2,814,715 € (without ischemia)/event avoided, 38,664 and 2,221,559 €/LYSO; for PCR ranged between 18,824 € (electrocardiographic and scintigraphic ischemia) and 46,377 € (without ischemia)/event avoided, 6464 and 36,604 €/LYSO. To CE: the cost-effectiveness values of the CABG and CPR in presence of electrocardiographic and scintigraphic ischemia were 269,904 €/CE-avoided and 24,428 €/CE-avoided, respectively; and the €/LYSO of the CABG and PCR were 152,488 and 13,801, respectively. The RCE was maintained for the current proportion of revascularized patients (12%/88%). Conclusions Combined ES and SPECT-MPI results, allows differentiation between patient groups, where the PCR and CABG are more cost-effective in different economic frameworks. The major CER in relation to CR, CE and TM occurs in patients with electrocardiographic and scintigraphic ischemia. PCR is more cost-effective than CABG.