Abstract
Contrast is a recommended but frequently unused tool in transthoracic echocardiography to improve detection of left ventricular thrombus in patients with ejection fraction (EF) ≤35%. The clinical and economic outcomes of a possible solution (i.e., universal contrast use) remain uncertain. To estimate clinical benefit, cost, and cost-effectiveness of a diagnostic strategy of universal use of contrast (vs no contrast) during echocardiography in patients with reduced EF, we created a decision analytic model using echocardiography sensitivity and specificity for left ventricular thrombus detection from a meta-analysis, as well as survival and cost estimates from published literature. Universal contrast use (vs nonuse) did not result in clinical or statistical improvement in estimated life years (8.509 vs 8.504) or quality-adjusted life years (5.620 vs 5.616). The cost of contrast was offset by reductions in subsequent health-care costs, resulting in similar total costs ($201,569 vs $201,573). In conclusion, although an intuitively attractive practice improvement strategy, universal contrast use strategy appears to offer no appreciable benefit to quality-adjusted survival or financial outcomes in patients with low EF.
References
Jun 1, 1984·Annals of Internal Medicine·D J WeinreichF J Pauletto
Nov 1, 1993·Journal of the American College of Cardiology·L J CrouseM D Smith
Oct 1, 1993·Journal of the American College of Cardiology·P T Vaitkus, E S Barnathan
Sep 12, 2000·The American Journal of Cardiology·D W KitzmanJ S Gottdiener
May 8, 2007·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·Robert OlszewskiHarald Becher
Jun 15, 2007·The American Journal of Cardiology·Nicolas MansencalOlivier Dubourg
Jul 5, 2008·Journal of the American College of Cardiology·Jonathan W WeinsaftRaymond J Kim
Jan 21, 2009·Annals of Internal Medicine·Mark H EckmanBrian F Gage
Apr 9, 2009·JAMA : the Journal of the American Medical Association·Christopher M O'ConnorUNKNOWN HF-ACTION Investigators
Oct 13, 2010·Archives of Internal Medicine·Kathleen T UnroeLesley H Curtis
Jul 16, 2011·JACC. Cardiovascular Imaging·Jonathan W WeinsaftRaymond J Kim
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Nov 5, 2011·Journal of Managed Care Pharmacy : JMCP·Sameer R GhateDiana I Brixner
May 4, 2012·The New England Journal of Medicine·Shunichi HommaUNKNOWN WARCEF Investigators
Sep 20, 2012·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Andrew H BriggsUNKNOWN ISPOR-SMDM Modeling Good Research Practices Task Force
Oct 10, 2012·Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance·Subodh B JoshiHoward Leong-Poi
Feb 22, 2013·Acute Cardiac Care·Chiara LanzilloFrancesco Romeo
May 17, 2013·Journal of the American Heart Association·Samuel W JoffeRobert J Goldberg
Nov 14, 2013·Circulation. Cardiovascular Quality and Outcomes·William J CanestaroNiteesh K Choudhry
Nov 28, 2013·Journal of the American Heart Association·Matthew SussmanMagdy Selim
Aug 3, 2014·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Thomas R PorterKevin Wei
Dec 3, 2015·The New England Journal of Medicine·Brian ClaggettUNKNOWN PARADIGM-HF Investigators