Noninvasive Imaging for the Diagnosis of Coronary Artery Disease: Focusing the Development of New Diagnostic Technology

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Abstract
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.