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IMPACT OF COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY ON OTHER DIAGNOSTIC TESTS

Published online by Cambridge University Press:  12 October 2012

Elena Berti ,
Laura Maria Beatrice Belotti ,
Filippo Cademartiri ,
Tiziana Giovannini ,
Rossana De Palma  and
Roberto Grilli
Elena Berti
Affiliation:
Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna (ASSR-RER) e-mail: [email protected]
Laura Maria Beatrice Belotti
Affiliation:
Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna (ASSR-RER)
Filippo Cademartiri
Affiliation:
Azienda Ospedaliero-Universitaria, Parma
Tiziana Giovannini
Affiliation:
Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna (ASSR-RER)
Rossana De Palma
Affiliation:
Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna (ASSR-RER)
Roberto Grilli
Affiliation:
Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna (ASSR-RER)
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Abstract

Objectives: Information on the impact of computed tomography coronary angiography (CTCA) on patterns of care is scarce. In particular, it is not clear if, and to what extent, its adoption actually leads to a reduction in the use of other diagnostics tools. The aim of this study was to evaluate whether the adoption of CTCA in Emilia-Romagna (an Italian region with a population of 4.4 million) had any effect on utilization rates of myocardial perfusion scintigraphy (MPS) and coronary angiography (CA).

Methods: Interrupted time series (ITS) were applied to monthly volumes of MPS and CA tests performed from 2003 to 2010, to assess trends in usage rates for those procedures before and after CTCA was adopted by all the healthcare organizations operating in the region.

Results: After an increase in the first year of CTCA introduction, its use remained stable over the study period. After September 2006, a significant decrease in MPS volumes (31 percent; p < .0001) and a much less tangible decrease in CA volumes (5 percent; p < .0001), were detected by ITS analyses.

Conclusions: This study demonstrates that the use of CTCA had a greater impact on MPS usage rates than on CA.

Keywords

Multislice computed tomographyCoronary angiographyMyocardial perfusion imagingIschemic heart disease
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 4 , October 2012 , pp. 424 - 428
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Auseon, AJ, Advani, SS, Bush, CA, et al.Impact of 64-slice multidetector computed tomography on other diagnostic studies for coronary artery disease. Am J Med. 2009;122:387d–391.CrossRefGoogle ScholarPubMed
2.Campbell, DT, Stanley, JC. Experimental and quasi-experimental designs for research. Chicago: Rand McNally; 1966.Google Scholar
3.Carroll, N. Application of segmented regression analysis to the Kaiser Permanente. Colorado Critical Drug Interaction Program. Kaiser Permanente, Denver CO. http://www.wuss.org/proceedings09/09WUSSProceedings/papers/anl/ANL-Carroll.pdf (accessed Month day, year).Google Scholar
4.Chow, BJ, Abraham, A, Wells, GA, et al.Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging. 2009;2:16–23.CrossRefGoogle ScholarPubMed
5.Decision memo for computed tomographic angiography (CAG-00385N). In: Medicare national coverage determinations manual. http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx (accessed March 19, 2012).Google Scholar
6.Draper, N, Smith, H. Applied regression analyses. New York: Wiley; 1981.Google Scholar
7.Geleijnse, ML, Fioretti, PM, Roelandt, JR. Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol. 1997;30:595–606.CrossRefGoogle ScholarPubMed
8.Gibbons, RJ, Abrams, J, Chatterjee, K, et al.American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients with Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Chronic Stable Angina). Circulation. 2003;107:149–158.Google Scholar
9.High Scientific Council Position Paper. The medical isotope crisis. European Nuclear Society Bulletin. 2009; Issue No. 26. http://www.euronuclear.org/e-news/e-news-26/hsc-statement.htm (accessed Month day, year).Google Scholar
10.Hurlock, GS, Higashino, H, Mochizuki, T. History of cardiac computed tomography: Single to 320-detector row multislice computed tomography. Int J Cardiovasc Imaging. 2009;25 (Suppl 1):31–42.CrossRefGoogle ScholarPubMed
11.Mark, DB, Berman, DS, Budoff, MJ, et al.ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010;121:2509–2543.Google Scholar
12.Mowatt, G, Vale, L, Brazzelli, M, et al.Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Health Technol Assess. 2004;8:iii-iv, 1–207.CrossRefGoogle ScholarPubMed
13.Ollendorf, DA, Kuba, M, Pearson, SD. The diagnostic performance of multi-slice coronary computed tomographic angiography: A systematic review. J Gen Intern Med. 2011;26:307–316.CrossRefGoogle ScholarPubMed
14.Redberg, RF, Walsh, J. Pay now, benefits may follow–the case of cardiac computed tomographic angiography. N Engl J Med. 2008;359:2309–2311.CrossRefGoogle ScholarPubMed
15.Schuetz, GM, Zacharopoulou, NM, Schlattmann, Pet al., Meta-analysis: Noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med. 2010;152:167–177.CrossRefGoogle ScholarPubMed
16.Taylor, AJ, Cerqueira, M, Hodgson, JM, et al.ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56:1864–1894.CrossRefGoogle Scholar
17.Van Brabandt, H, Camberlin, C, Cleemput, I. 64-Slice computed tomography imaging of coronary arteries in patients suspected for coronary artery disease. Health Technology Assessment (HTA). Brussels: Belgian Healthcare Knowledge Center (KCE); 2008. KCE Reports 82 C (D/2008/10.273/42).Google Scholar
18.Wagdi, P, Alkadhi, H. The impact of cardiac CT on the appropriate utilization of catheter coronary angiography. Int J Cardiovasc Imaging. 2010;26:333–344.CrossRefGoogle ScholarPubMed