An Overview on Coronary Heart Disease (A Comparative Evaluation of Turkey and Europe) and Cost-effectiveness of Diagnostic Strategies

Abstract

Objective: Coronary heart disease (CHD) is the leading cause of death for men and women in Turkey as it is in Europe and US. The prevalence of the disease is 3.8% in Turkey and 200,000 patients are added to the pool of CHD annually Because of genetic predisposition and high proportions of physical inactivity, smoking habit, and obesity, CHD is encountered in earlier ages in our country So, the economic burden of the disease is expected to be relatively high, but the amount of health expenditure is not always parallel to the prevalence of a disease in the community. This article was written to overview CHD statistics to make a comparison between Turkey and some European countries and to investigate the value of myocardial perfusion scan (MPS) as a gatekeeper in diagnosing CHD before invasive coronary angiography (ICA). The consequences were evaluated for Turkey In diagnosis; noninvasive testing gains importance in connection with the new approaches in treatment strategies, because a direct ICA strategy results in higher rates of revascularization without improvement in clinical outcomes. A "gatekeeper" is needed to select the patients who are not required to undergo angiography. MPS with its proved power in diagnosis and predicting prognosis, provides a cost-effective solution, and is accepted in some extensive analyses as a "gatekeeper" particularly in intermediate and high risk patients and in patients with known CHD. In conclusion, MPS may provide an optimal solution better than the ongoing situation in Turkey as well, when it is approved as a "gatekeeper in an algorithm before ICA.

Conflict of interest: None declared.

Keywords: Coronary heart disease; cardiac noninvasive testing; cost-effectiveness; myocardial perfusion scan.

Figure 1. Deaths by cause for high-, middle and low-income countries in theFuture

Figure 10. Observed cardiac death rates over the follow-up period in patientsundergoing revascularization (Revasc Rx) vs medical therapy (Medical Rx) as afunction of the amount of inducible ischemia. (P<0.0001) Ref. 88

Figure 2. Major causes of death by age in Europe from Euro Heart survey2006 (9)

Figure 3. Age standardized mortality rates in 45-74 years old people withCHD in Europe, 2000 (15,16,17). Modified from Ref 15

Figure 4. Patient population, new cases and death from CHD in Turkishadults ([ref:15]15[/ref]). With permission of A. Onat

Figure 5. Economic burden of CHD in EU, in 2003 (Overall cost is 49 bilion a year)

Figure 6. Direct health care cost for CHD in EU ( 23 billion a year)

Figure 7. Age-standardized DALYs rate for CHD, 2002, Europe (11)

Figure 8. Age-standardized DALYs rates and mortality rates in someEuropean countries

Figure 9. Gross National Income Per Capital (GNIpc) of the same Europeancountries (PPP$)