Thursday, 17 November 2011

Financial Consequences of New Guidelines

This is a really interesting study for a number of reasons. When diagnosing the causes of angina, there has been a move away from exercise testing ((too many false positives and false negatives) and towards using CT coronary calcium scoring and CT coronary angiography.  These evidence based changes have appeared in NICE issued guidelines. 
This study suggest that such a strategy results in a greater number of invasive coronary angiograms and a greater number of revascularisations - both percutaneous (PCI/coronary stenting) and surgical CABG) - thus making it a more expensive strategy with no change in mortality.
In the UK , the number of revascularisation procedures (both PCI and CABG) for stable angina is plummeting. It will be interesting to see whether increased use of CT angiography might slow or reverse this decline.