According to the study, beneficiaries who received CCTA in an outpatient setting were about twice as likely than those patients who received stress testing to under undergo subsequent cardiac catheterization; more than two times as likely to receive a percutaneous coronary intervention, such as a balloon angioplasty or a stent placement that is used to open narrowed coronary arteries; and roughly three times more likely to have coronary artery bypass graft surgery.
Stress testing uses electrocardiography, echocardiography, or myocardial perfusion scintigraphy.
The researchers found that use of CCTA has increased steadily with Medicare patients, from 38,171 procedures in 2006 to 78,009 procedures in 2008.
Although CCTA makes up less than 4% of noninvasive testing for coronary heart disease in the U.S., the procedure may detect atherosclerotic plaques that are not “hemodynamically significant” and that can lead to additional test and procedures, according to the analysis.
“This higher use of invasive procedures after CCTA appears to have led in turn to substantially higher spending for medical care at 180 days,” wrote the researchers.
Patients who underwent CCTA reported almost 40% higher coronary heart disease-related spending at total spending of $14,943, compared to patients who received MPS ($10,626), echocardiography ($8,202) and exercise ECG ($7,991).
“Our data suggest that increased use of CCTA may greatly increase subsequent diagnostic testing and invasive cardiac procedures,” wrote the researchers. “The increased use of invasive procedures and the higher spending on care after CCTA documented in this study suggest that clinicians and policy makers should critically evaluate the use of CCTA in clinical practice, based on studies of subsequent outcomes.”