Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/2756
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dc.contributor.authorFerreira, AM-
dc.contributor.authorMarques, H-
dc.contributor.authorAraújo Gonçalves, P-
dc.contributor.authorCardim, N-
dc.identifier.citationArq Bras Cardiol. 2014 Apr;102(4):391-402pt_PT
dc.description.abstractBACKGROUND: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. OBJECTIVE: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. METHODS: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. RESULTS: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. CONCLUSIONS: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.pt_PT
dc.publisherSociedade Brasileira de Cardiologiapt_PT
dc.subjectBayes Theorempt_PT
dc.subjectCardiac Imaging Techniquespt_PT
dc.subjectCoronary Artery Diseasept_PT
dc.subjectCost-Benefit Analysispt_PT
dc.subjectDecision Treespt_PT
dc.subjectExercise Testpt_PT
dc.subjectFalse Negative Reactionspt_PT
dc.subjectFalse Positive Reactionspt_PT
dc.subjectReference Valuespt_PT
dc.subjectSensitivity and Specificitypt_PT
dc.subjectHSM IMApt_PT
dc.titleCost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugalpt_PT
degois.publication.titleArquivos Brasileiros de Cardiologiapt_PT
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