Coste-efectividad de la SPECT de perfusión miocárdica y de la prueba de esfuerzo en relación con la revascularización coronaria, eventos cardíacos y mortalidad total. Registro de 8.496 pacientes

espanolObjetivo Analisis de la relacion coste-efectividad (RCE) del electrocardiograma de esfuerzo y de la SPECT de perfusion miocardica esfuerzo-reposo en relacion con la revascularizacion coronaria (RC), eventos cardiacos (EC) y mortalidad total (MT). Material y metodos Se estudiaron 8.496 pacientes con SPECT y seguimiento medio de 5,3 ± 3,5 anos. Evaluamos la RCE para la RC quirurgica (RCQ) y percutanea (RCP) (45,6%/54,4%) de acuerdo con los resultados de la isquemia electrocardiografica y gammagrafica. La efectividad se evaluo como MT, EC, LYSO (life-year-saved-observed) y EC-LYSO. Los analisis de costes se realizaron desde la perspectiva del pagador de atencion medica. El analisis de sensibilidad fue considerando las relaciones RCQ/RCP actuales (12%/88%). Resultados Al combinar los resultados del electrocardiograma de esfuerzo y de la gammagrafia, los valores de coste-efectividad para la RCQ variaron entre 112.589 € (isquemia electrocardiografica y gammagrafica) y 2.814.715 € (sin isquemia)/evento evitado, y entre 38.664 y 2.221.559 €/LYSO; y para la RCP entre 18.824 € (isquemia electrocardiografica y gammagrafica) y 46.377 € (sin isquemia)/evento evitado, y entre 6.464 y 36.604 €/LYSO. Para el EC: los valores de coste-efectividad de la RCQ y RCP en presencia de isquemia electrocardiografica y gammagrafica fueron de 269.904 €/EC evitado y de 24.428 €/EC evitado, respectivamente; y los €/LYSO de la RCQ y RCP fueron de 152.488 y 13.801, respectivamente. Se mantuvo la misma RCE para la proporcion actual de pacientes revascularizados (12%/88%). Conclusiones El analisis combinado de las imagenes de la SPECT y del electrocardiograma de esfuerzo permite la diferenciacion entre grupos de pacientes en donde la RCP y la RCQ son mas rentables. La mayor RCE en relacion con la RC, EC y MT se da en los pacientes con isquemia electrocardiografica y gammagrafica. La RCP es mas coste-efectiva que la RCQ. EnglishObjective 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 8,496 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, 6,464 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.