Cosimo Loré

Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

BackgroundDiagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients.MethodsWe evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6).ResultsThe predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results

Retinoblastoma and the genetic theory of cancer: an old paradigm trying to survive to the evidence.

2.051 for cTn-I,

Sensory axons excitability changes in carpal tunnel syndrome after neural mobilization

2.086 for cTn-T,

The Epigenetic Origin of Retinoblastoma

1.890 for ex-ECG,

Radiological informed consent in cardiovascular imaging: towards the medico-legal perfect storm?

803 for ex-Echo,

Microsatellite instability in three cases of embryonal rhabdomyosarcoma of the orbit.

533 for PhSE,

Retinoblastoma as an Epigenetic Disease: A Proposal

1.521 for ex-SPECT-Tc (

13q deletion syndrome associated with retinoblastoma and clinical anophthalmos of the opposite eye

1.634 including cost of extra risk of cancer) and

The growth of a lie and the end of conventional medicine

29.673 for CA (

The growth of a lie and the end of “conventional”.

29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×.ConclusionStress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void.