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2 Multislice CT in Coronary Heart Disease KCE Reports 82 6.1.2 Multislice Cardiac CT in Belgium................................................................................................49 6.2 REGULATORY ISSUES..............................................................................................................................51 6.2.1 Authorization ..................................................................................................................................51 6.2.2 Planning.............................................................................................................................................51 6.2.3 Financing...........................................................................................................................................51 6.2.4 Patients referral for CT examinations .......................................................................................51 6.3 COVERAGE OF MULTI-SLICE CT ANGIOGRAPHY .......................................................................52 6.3.1 United States of America..............................................................................................................52 6.3.2 Canada..............................................................................................................................................54 6.3.3 Australia ...........................................................................................................................................54 6.3.4 The Netherlands.............................................................................................................................55 6.3.5 France ...............................................................................................................................................55 6.3.6 Germany...........................................................................................................................................55 6.3.7 England..............................................................................................................................................56 6.3.8 Belgium .............................................................................................................................................57 6.4 DISCUSSION...............................................................................................................................................57 7 PATIENT ISSUES.......................................................................................................... 59 7.1 TRUE NEGATIVE TEST RESULT............................................................................................................59 7.2 FALSE NEGATIVE TEST RESULT...........................................................................................................59 7.3 TRUE POSITIVE TEST RESULT...............................................................................................................59 7.4 FALSE POSITIVE TEST RESULT..............................................................................................................60 8 GENERAL DISCUSSION.............................................................................................. 61 8.1 TECHNICAL EFFICACY...........................................................................................................................61 8.2 DIAGNOSTIC ACCURACY....................................................................................................................62 8.3 DIAGNOSTIC THINKING ......................................................................................................................62 8.4 THERAPEUTIC IMPACT ..........................................................................................................................62 8.5 PATIENT OUTCOMES.............................................................................................................................63 8.6 COST-EFFECTIVENESS ............................................................................................................................63 9 CONCLUSIONS ............................................................................................................ 64 9.1 TECHNICAL EFFICACY...........................................................................................................................64 9.2 DIAGNOSTIC ACCURACY....................................................................................................................64 9.3 DIAGNOSTIC THINKING ......................................................................................................................64 9.4 THERAPEUTIC IMPACT ..........................................................................................................................64 9.5 PATIENT OUTCOMES.............................................................................................................................64 9.6 COST-EFFECTIVENESS ............................................................................................................................64 10 APPENDICES................................................................................................................. 65 REFERENCES ........................................................................................................................... 92
KCE Reports 82 Multislice CT in Coronary Heart Disease 3 GLOSSARY ACC American College of Cardiology ACS Acute Coronary Syndrome AHA American Heart Association AMI Acute Myocardial Infarction AR Absolute Risk ARR Absolute Risk Reduction b.p.m. beats per minute CABG Coronary Artery Bypass Grafting CAC Coronary Artery Calcium CAD Coronary Artery Disease CCA Conventional coronary angiography CHD Coronary Heart Disease CPU Chest Pain Unit CVD Cardiovascular Disease DSE Dobutamine Stress Echocardiogram EBCT Electron Beam Computed Tomography ECG Electrocardiogram ED Emergency Department EF Ejection Fraction ER Emergency Room ESC European Society of Cardiology FN False negative FP False Positive HF Heart Failure HR Hazard Rate HTA Health Technology Assessment ICER Incremental Cost-Effectiveness Ratio IHD Ischemic Heart Disease LR Likelihood Ratio LVEF Left Ventricular Ejection Fraction MI Myocardial Infarction MPI Myocardial Perfusion Imaging MPS Myocardial Perfusion Scintigraphy MRI Magnetic Resonance Imaging MSCT Multislice computed tomography (of coronary arteries) NHSEED National Health Service Economic Evaluation Database NNT Number Needed to Treat NUR Nationale Unie der Radiologen NYHA New York Heart Association PCI Percutaneous Coronary Intervention QALY Quality Adjusted Life Year RCT Randomized Controlled Trial RR Relative Risk RRR Relative Risk Reduction SR Systematic Review STEMI ST-Elevation Myocardial Infarction TN True Negative TP True Positive UNR Union Nationale des Radiologues x-SCT x-slice computed tomography (of coronary arteries): e.g. 64-SCT
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KCE reports 33 Effects and costs of
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