Aim This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population... Show moreAim This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population of patients from the Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease (EVINCI) study. Methods and results Cost-effectiveness analysis was performed in 350 patients (209 males, mean age 59 +/- 9 years) with symptoms of suspected stable CAD undergoing computed tomography coronary angiography (CTCA) and at least one cardiac imaging stress-test prior to invasive coronary angiography (ICA) and in whom imaging exams were analysed at dedicated core laboratories. Stand-alone stress-tests or combined non-invasive strategies, when the first exam was uncertain, were compared. The diagnostic end-point was obstructive CAD defined as > 50% stenosis at quantitative ICA in the left main or at least one major coronary vessel. Effectiveness was defined as the percentage of correct diagnosis (cd) and costs were calculated using country-specific reimbursements. Incremental cost-effectiveness ratios (ICERs) were obtained using per-patient data and considering "no-imaging" as reference. The overall prevalence of obstructive CAD was 28%. Strategies combining CTCA followed by stress ECHO, SPECT, PET, or stress CMR followed by CTCA, were all cost-effective. ICERs values indicated cost saving from - 969euro/cd for CMR-CTCA to - 1490euro/cd for CTCA-PET, - 3092euro/cd for CTCA-SPECT and - 3776euro/cd for CTCA-ECHO. Similarly when considering early revascularization as effectiveness measure. Conclusion In patients with suspected stable CAD and low prevalence of disease, combined non-invasive strategies with CTCA and stress-imaging are cost-effective as gatekeepers to ICA and to select candidates for early revascularization. Show less
Scattering of light in the presence of nano-structured materials, i.e. with features in the order of the wavelength of the light or smaller, reveals details of how light interacts with matter at... Show moreScattering of light in the presence of nano-structured materials, i.e. with features in the order of the wavelength of the light or smaller, reveals details of how light interacts with matter at the nanoscale. In this dissertation we present four cases of light scattering on nano-structures. First we describe how light confined in 2D structures, namely a dielectric membrane and a metal layer, interacts with either a single nano-hole or a hole-array. Then, we study two cases of light propagating in random scattering media: we show how phase modulation can be used to measure scattering properties in a volume scatterer (e.g. white paint), and we investigate light transport in a rough thin-film silicon solar cell. Show less
Mariani, F.; Löffler, W.; Aas, M.; Ojambati, O.S.; Hong, P.; Vos, W.L.; Exter, M.P. van 2018
