CT Angiography and Stress Test Show Similar Costs

Computed tomographic angiography (CTA) and functional diagnostic testing strategies for patients with suspected coronary artery disease (CAD) have similar costs, according to a new study.

Researchers at Duke University (Durham, NC, USA), the U.S. National Heart, Lung and Blood Institute (Bethesda, MD, USA), and other institutions conducted a prospective economic study involving 9,649 patients at 190 U.S. centers enrolled in the PROspective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study between July 2010 and September 2013. Median follow-up was 25 months.


The researchers estimated the technical costs of the initial (outpatient) testing strategy, hospital-based costs and physician fees, discounted at 3% annually and estimated out to three years. The results showed that the mean costs at 90 days were USD 2,494 for the CTA strategy, versus USD 2,240 for the functional strategy, a mean difference of USD 254. The difference was associated with more revascularizations and catheterizations with CTA use. The study was published on May 24, 2016, in Annals of Internal Medicine.

“Despite some fair differences in the prices of these diagnostic tests, there was not a statistical difference between the costs over three years of follow-up,” said lead Daniel Mark, MD, MPH, of Duke. “Coronary CT angiography may not be quite the hoped-for holy grail of cardiology, but its more liberal use following the standards set in PROMISE will not hurt patients, and will not cause a major additional cost burden on the health care system.”

Current guidelines of the American Heart Association (AHA, Dallas, TX, USA) and the American College Cardiology (ACC) call for a stress tests in all patients who show signs of CAD to confirm the diagnosis and define severity of the blockage. CTA is reserved only for patients with borderline stress test results. However, according to the researchers, the much higher accuracy of CTA may be a better first-line test in people with symptoms suggestive of a blocked artery.

Related Links:
Duke University
U.S. National Heart, Lung and Blood Institute