Objective: The primary aim of the present study was to calculate the actual costs of four diagnostic tests for the detection of coronary artery disease in the Netherlands using a microcosting methodology. As a secondary objective, the cost effectiveness of eight diagnostic strategies was examined, using microcosting and reimbursement fees subsequently as the cost estimate. Design: A multicenter, retrospective cost analysis from a hospital perspective. Setting: The study was conducted in three general hospitals in the Netherlands for 2006. Interventions: Exercise electrocardiography (exECG), stress echocardiography (sECHO), single-photon emission computed tomography (SPECT) and coronary angiography (CA). Results: The actual costs of exECG, sECHO, SPECT and CA were €33, 216, 614 and 1300 respectively. For all diagnostic tests, labour and indirect cost components (overheads and capital) together accounted for over 75% of the total costs. Consumables played a relatively important role in SPECT (14%). Hotel and nutrition were only applicable to SPECT and CA. Diagnostic services were solely performed for CA, but their costs were negligible (2%). Using microcosting estimates, exECG-sECHO-SPECT-CA was the most and CA the least cost effective strategy (€397 and 1302 per accurately diagnosed patient). Using reimbursement fees, exECG-sECHO-CA was most and SPECT-CA least cost effective (€147 and 567 per accurately diagnosed patient). Conclusions: The use of microcosting estimates instead of reimbursement fees led to different conclusions regarding the relative cost effectiveness of alternative strategies.

Actual cost, Computerized tomography, Consumables, Coronary angiography, Coronary artery disease, Cost accounting, Cost analysis, Cost benefit analysis, Cost effectiveness, Cost estimate, Costs, Diagnostic strategy, Diagnostic test, Diagnostic tests, Echocardiography, Hospitals, Indirect costs, Least cost, Microcosting, Netherlands, Single photon emission computed tomography, Stress echocardiography, Testing, Total costs, angiocardiography, article, cardiac patient, coronary artery disease, cost effectiveness analysis, diagnostic accuracy, diagnostic test, exercise electrocardiography, female, general hospital, health care cost, hospitalization, human, major clinical study, male, medical service, mortality, nutrition, priority journal, reimbursement, retrospective study, sensitivity and specificity, single photon emission computer tomography, stress echocardiography
dx.doi.org/10.1016/j.ejrad.2008.07.002, hdl.handle.net/1765/17950
European Journal of Radiology
Erasmus MC: University Medical Center Rotterdam

Tan, S.S, Oppe, M, Zoet-Nugteren, S.K, Niezen, R.A, Kofflard, M.J.M, ten Cate, F.J, & Hakkaart-van Roijen, L. (2009). A microcosting study of diagnostic tests for the detection of coronary artery disease in the Netherlands. European Journal of Radiology, 72(1), 98–103. doi:10.1016/j.ejrad.2008.07.002