Cost-Effectiveness of Stress-Echocardiography

Assessment of cost issues has assumed increasing importance in cardiology, as it has in all medicine. As managed care organizations, Medicare, and other payers have come under increased pressure to contain rising health care costs, physicians have been increasingly forced to justify their clinical decisions by relying on evidence-based medicine and outcomes research. Accordingly, proponents of particular diagnostic or treatment strategies need to evaluate these strategies not only by clinical outcomes, but also by cost and cost-effectiveness.18, 26 Stress echocardiography (stress echo), which includes both exercise echocardiography and pharmacologic stress (usually dobutamine) echocardiography is a relatively new diagnostic testing strategy that has rapidly assumed an important role in cardiovascular diagnosis.51 The diagnostic accuracy is similar to that of stress nuclear (SN) studies, such as exercise single photon emission computed tomography (SPECT) and dipyridamole-SPECT. Because it is one of several potentially useful diagnostic procedures in cardiovascular medicine, stress echo should be evaluated not simply in terms of its effectiveness in diagnosing coronary artery disease (CAD) and assessing prognosis, effectiveness of treatment, and myocardial viability, but should also be examined in terms of relative costs and benefits compared with other diagnostic modalities.5