Impact of contrast echocardiography on diagnostic algorithms: Pharmacoeconomic implications

• Type of Material: Article
• Authors: Leslee J Shaw, Emory University
• Language: English
• Date: 1997-10-01
• Publisher: Wiley Open Access: Various Creative Commons Licenses
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 1997 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/clc.4960201309
• Title of Journal or Parent Work: Clinical Cardiology
• ISSN: 0160-9289
• Volume: 20
• Issue: 10
• Start Page: 39
• End Page: 48
• Keywords: Cardiac & Cardiovascular Systems; RISK STRATIFICATION; Life Sciences & Biomedicine; EMISSION COMPUTED-TOMOGRAPHY; disease management; contrast echocardiography; CHEST PAIN; CORONARY-ARTERY DISEASE; PROGNOSTIC VALUE; economics; COST-EFFECTIVENESS; Science & Technology; patient outcomes; DOBUTAMINE ECHOCARDIOGRAPHY; ACUTE MYOCARDIAL-INFARCTION; Cardiovascular System & Cardiology; TC-99M SESTAMIBI; diagnostic algorithms; cost effectiveness; ISCHEMIC-HEART-DISEASE; EchoGen(R)
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

The major goal of medicine in the era of managed care is to control escalating costs and to attain a high level of quality health care. Capitation has limited access to expensive and unnecessary testing, placing an emphasis on the prudent use of available technology. A vast armamentarium of avail- able diagnostic screening tests are available within cardiology. Routine two-dimensional (2-D) echocardiography is a high-quality, low-cost test that provides enhanced portability and real-time test interpretation over other noninvasive test modalities. The echocardiogram may cost up to 50% less than competitive nuclear single-photon emission computed tomography (SPECT) imaging. However, on average 10% of routine and 33% of stress echocardiograms are suboptimal (disproportionately affecting obese patients and those with lung disease). Myocardial contrast echocardiography has been shown to provide enhanced endocardial border delineation and lift ventricular opacification, to enhance Doppler signal, and to provide information on myocardial perfusion. In several recent phase II and III studies, the use of a contrast agent has been shown to improve the diagnostic accuracy of echocardiography substantially. Improvements in the diagnostic capabilities of echocardiography have been shown to (1) impact upon downstream repetitive testing in patients with an initially nondiagnostic echocardiogram, (2) potentially increase laboratory throughput, and (3) reduce the rate of false- positive and negative tests as a result of improved image quality. As clinical and cost-effectiveness parallel one another, the use of myocardial contrast echocardiography in selected patient cohorts will result in improved diagnostic accuracy and a cost-effective pattern of care.