Maria G.M. Hunink, MD, PhD; Karen M. Kuntz, ScD; Kirsten E. Fleischmann, MD, MPH; Thomas J. Brady, MD
Acknowledgments: Dr. Hunink was supported in part by a Persoongerichte Impuls voor Onderzoeksgroepen met Nieuwe Ideëen voor Excellente Research (PIONIER 900-92-146) award from the Netherlands Organization for Scientific Research. Drs. Fleischmann and Kuntz were supported by a project grant from the American Society of Echocardiography. Dr. Fleischmann is the recipient of a Clinical Investigator Development Award (1K08HL02964-01) from the National Heart, Lung, and Blood Institute.
Requests for Reprints: Maria G.M. Hunink, MD, PhD, Department of Epidemiology and Biostatistics and Department of Radiology, Erasmus Medical Center Rotterdam, Room EE21-40a, Box 1738, 3000 DR Rotterdam, the Netherlands; e-mail, email@example.com. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Hunink: Department of Epidemiology and Biostatistics and Department of Radiology, Erasmus Medical Center Rotterdam, Room EE21-40a, Box 1738, 3000 DR Rotterdam, the Netherlands.
Dr. Kuntz: Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115-5924.
Dr. Fleischmann: School of Medicine Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, M 326, San Francisco, CA 94143-0214.
Dr. Brady: Center for Innovative Minimally Invasive Therapy, Partners Healthcare System, Massachusetts General Hospital, 55 Fruit Street, BAR 703, Boston, MA 02114-2696.
Hunink MG, Kuntz KM, Fleischmann KE, Brady TJ. Noninvasive Imaging for the Diagnosis of Coronary Artery Disease: Focusing the Development of New Diagnostic Technology. Ann Intern Med. 1999;131:673-680. doi: 10.7326/0003-4819-131-9-199911020-00008
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Published: Ann Intern Med. 1999;131(9):673-680.
New tests, such as magnetic resonance imaging (MRI) and electron-beam computed tomography (CT), are being developed for the diagnosis of coronary artery disease.
To determine the conditions that a new test must meet to be a cost-effective alternative to established imaging tests.
Decision model and cost-effectiveness analysis.
Literature review and meta-analysis.
55-year-old men and 65-year-old women presenting with chest pain.
Lifetime of the patient.
Health care policy.
MRI, electron-beam CT, exercise echocardiography, exercise single-photon emission CT, and coronary angiography.
Target sensitivity and specificity values for a new noninvasive test.
Assuming that society is willing to pay $75 000 per quality-adjusted life-year (QALY) gained, a new test that costs $1000 would need a sensitivity of 94% and a specificity of 90% to be cost-effective.
Assuming that society is willing to pay $50 000 per QALY gained, a new test that costs $1000 or more would never be cost-effective. For a test that costs $500, the sensitivity and specificity must each be 95%.
New imaging techniques, such as MRI and electron-beam CT, must be relatively inexpensive and have excellent sensitivity and specificity to be cost-effective compared with other techniques for the diagnosis of coronary artery disease. Similar analyses in other areas of health care may help to focus the development of new diagnostic technology.
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Cardiology, Cardiac Diagnosis and Imaging, Coronary Heart Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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