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Ann Thorac Surg 2002;73:1403-1409
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease

Paul B. Jacklin, MS*a, Sally F. Barrington, MRCPb, James C. Roxburgh, FRCSb, Graham Jackson, FACCb, Dimitrios Sariklis, PhDb, Peter A. West, DPhilb, Michael N. Maisey, MDb

a London School of Hygiene and Tropical Medicine, London, United Kingdom
b Guy’s and St. Thomas’ Hospitals, London, United Kingdom

Accepted for publication December 20, 2001.

* Address reprint requests to Mr Jacklin, London School of Hygiene and Tropical Medicine, Health Services Research Unit, Keppel St, London WC1E 7HT, UK
e-mail: paul.jacklin{at}lshtm.ac.uk

Background. Revascularization of patients with ischemic heart disease and poor left ventricular function for surgical procedures is expensive and carries considerable risks, but may improve survival for patients with hibernating myocardium. Positron emission tomography can detect hibernating myocardium, and may be cost-effective if used to select patients for operation.

Methods. An economic model was developed to compare the cost-effectiveness of three management strategies: (1) coronary artery bypass grafting for all patients; (2) using positron emission tomography to select candidates for coronary artery bypass grafting, those without hibernation remaining on medical therapy; and (3) medical therapy for all patients. The model used data from our hospital and the published literature. A sensitivity analysis was also undertaken.

Results. Positron emission tomography was cost-effective in selecting patients for operation. In a hypothetical population of 1,000 patients, using positron emission tomography saved marginally more life-years and cost approximately £3 million less. Using positron emission tomography before coronary artery bypass grafting instead of all patients receiving medical treatment saved lives but was more expensive. The incremental cost per life-year saved was £77,000. The sensitivity analysis showed that the prevalence of hibernation and the survival rate of patients refused revascularization on the basis of the positron emission tomography scan were the areas most likely to influence cost-effectiveness.

Conclusions. Positron emission tomography may be cost-effective to select patients with poor left ventricular function for coronary artery bypass grafting.




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