Cost-effectiveness of exercise 201Tl myocardial SPECT in patients with chest pain assessed by decision-tree analysis

To evaluate the potential cost-effectiveness of exercise 201Tl myocardial SPECT in outpatients with angina-like chest pain, we developed a decision-tree model which comprises three 1000-patients groups, i.e., a coronary arteriography (CAG) group, a follow-up group, and a SPECT group, and total cost and cardiac events, including cardiac deaths, were calculated. Variables used for the decision-tree analysis were obtained from references and the data available at out hospital. The sensitivity and specificity of 201Tl SPECT for diagnosing angina pectoris, and its prevalence were assumed to be 95%, 85%, and 33%, respectively. The mean costs were 84.9 x 104 yen/patient in the CAG group, 30.2 x 104 yen/patient in the follow-up group, and 71.0 x 104 yen/patient in the SPECT group. The numbers of cardiac events and cardiac deaths were 56 and 15, respectively in the CAG group, 264 and 81 in the follow-up group, and 65 and 17 in the SPECT group. SPECT increases cardiac events and cardiac deaths by 0.9% and 0.2%, but it reduces the number of CAG studies by 50.3%, and saves 13.8 x 104 yen/patient, as compared to the CAG group. In conclusion, the exercise 201Tl myocardial SPECT strategy for patients with chest pain has the potential to reduce health care costs in Japan. (author)