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Guest Editor: Gambhir S. S.

The Quarterly Journal of Nuclear Medicine 2000 June;44(2):138-52


language: English

Clinical and economic outcomes assessment in nuclear cardiology

Shaw L. J., Miller D. D. *, Berman D. S. **, Hachamovitch R. ***

From the Emory University, Atlanta, Georgia, USA *St. Louis University Health Sciences Center St. Louis, Missouri, USA **Cedars-Sinai Medical Center; Los Angeles, California, USA ***St. Francis Medical Center, New York, USA


The ­future of nucle­ar med­i­cine pro­ce­dures, as under­stood with­in our cur­rent eco­nom­ic cli­mate, ­depends ­upon its abil­ity to pro­vide rel­e­vant clin­i­cal infor­ma­tion at sim­i­lar or low­er com­par­a­tive ­costs. With an ­ever-increas­ing empha­sis on ­cost con­tain­ment, out­come assess­ment ­forms the ­basis of pre­serv­ing the qual­ity of ­patient ­care. Today, out­comes assess­ment encom­pass­es a ­wide ­array of sub­jects includ­ing clin­i­cal, eco­nom­ic, and human­is­tic (i.e., qual­ity of ­life) out­comes. For nucle­ar car­di­ol­o­gy, evi­dence-­based med­i­cine ­would ­require a thresh­old lev­el of evi­dence in ­order to jus­ti­fy the add­ed ­cost of any ­test in a ­patient’s ­work-up. This evi­dence ­would ­include ­large mul­ti­cen­ter, obser­va­tion­al ­series as ­well as ran­dom­ized ­trial ­data in suf­fi­cient­ly ­large and ­diverse ­patient pop­u­la­tions. The new move­ment in evi­dence-­based med­i­cine is ­also ­being ­applied to the intro­duc­tion of new tech­nol­o­gies, in par­tic­u­lar ­when com­par­a­tive modal­ities ­exist. In the ­past 5 ­years, we ­have ­seen a dra­mat­ic ­shift in the qual­ity of out­comes ­data pub­lished in nucle­ar car­di­ol­o­gy. This ­includes the use of sta­tis­ti­cal­ly rig­or­ous ­risk-adjust­ed tech­niques as ­well as ­large pop­u­la­tions (i.e., >500 ­patients) rep­re­sent­ing mul­ti­ple ­diverse med­i­cal ­care set­tings. This has ­been the ­direct ­result of the devel­op­ment of mul­ti­ple out­comes data­bas­es ­that ­have now ­amassed thou­sands of ­patients ­worth of ­data. One of the ben­e­fits of exam­in­ing out­comes in ­large ­patient data­sets is the abil­ity to ­assess indi­vid­u­al end­points (e.g., car­diac ­death) as com­pared ­with small­er data­sets ­that ­often ­assess com­bined end­points (e.g., ­death, myo­car­dial infarc­tion, or ­unstable angi­na). New tech­nol­o­gies for the diag­no­sis of cor­o­nary ­artery dis­ease ­have con­trib­ut­ed to the ris­ing ­costs of ­care. In the United States and in Europe, ­costs of ­care ­have ris­en dra­mat­i­cal­ly, con­sum­ing an ­ever-increas­ing ­amount of avail­able resourc­es. The over­use of diag­nos­tic angio­gra­phy ­often ­leads to unnec­es­sary revas­cu­lar­iza­tion ­that ­does not ­lead to improve­ment in out­come. Thus, the poten­tial ­exists ­that ­stress ­SPECT imag­ing, a high­ly effec­tive diag­nos­tic ­tool, ­could ­effect sub­stan­tial ­change in reduc­ing inap­pro­pri­ate use of an inva­sive pro­ce­dure result­ing in ­cost effec­tive car­diac ­care. A syn­the­sis of cur­rent eco­nom­ic evi­dence in gat­ed ­SPECT imag­ing ­will be pre­sent­ed. In con­clu­sion, a cur­rent ­state of the evi­dence ­review is pre­sent­ed on the clin­i­cal and eco­nom­ic ­data ­using nucle­ar car­di­ol­o­gy imag­ing.

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