HealthDay News – For patients with coronary artery disease (CAD) enrolled in the PROMISE study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), costs are similar for initial use of at least 64-slice multidetector computed tomographic angiography (CTA) vs functional diagnostic testing strategies, according to research published online May 24 in the Annals of Internal Medicine.

Daniel B. Mark, MD, MPH, from the Duke University Medical Center in Durham, North Carolina, and colleagues conducted an economic analysis for PROMISE using data for 9649 patients enrolled in the study who were followed for a median of 25 months. They estimated the technical costs of the outpatient testing strategy and hospital-based costs, and obtained data on physician fees.

Researchers found that the mean initial testing costs were $174 and $404 for exercise electrocardiography and CTA, respectively; $501 to $514 for pharmacologic and exercise stress echocardiography, respectively; and $946 to $1132 for exercise and pharmacologic stress nuclear testing, respectively. 

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At 90 days, the mean costs were $2494 and $2240 for the CTA and functional strategies, respectively. More revascularizations and catheterizations were seen with CTA use, accounting for the difference. The mean cost difference between the groups after 90 days and to 3 years remained small.

“Computed tomographic angiography and functional diagnostic testing strategies in patients with suspected CAD have similar costs through 3 years of follow-up,” the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical and medical device industries.


  1. Mark DB, Federspiel JJ, Cowper PA, et al; for the PROMISE Investigators. Economic outcomes with anatomical vs functional diagnostic testing for coronary artery disease. Ann Intern Med. doi: 10.7326/M15-2639.
  2. Xie JX, Shaw LJ. Measuring diagnostic health care costs in stable coronary artery disease: should we follow the money? Ann Intern Med. doi: 10.7326/M16-1048.