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We sought to provide cost\u2010effectiveness information to aid physicians and decision\u2010makers in selecting the most appropriate testing strategy. We used the state\u2010transitions (Markov) model from the Brazilian public health system perspective with a lifetime horizon. Diagnostic strategies were based on exercise electrocardiography (Ex\u2010<jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>), stress echocardiography (<jats:styled-content style=\"fixed-case\">ECHO<\/jats:styled-content>), single\u2010photon emission computed tomography (<jats:styled-content style=\"fixed-case\">SPECT<\/jats:styled-content>), computed tomography coronary angiography (<jats:styled-content style=\"fixed-case\">CTA<\/jats:styled-content>), or stress cardiac magnetic resonance imaging (C\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) as the initial test. Systematic review provided input data for test accuracy and long\u2010term prognosis. Cost data were derived from the Brazilian public health system. Diagnostic test strategy had a small but measurable impact in quality\u2010adjusted life\u2010years gained. Switching from Ex\u2010<jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>to<jats:styled-content style=\"fixed-case\">CTA<\/jats:styled-content>\u2010based strategies improved outcomes at an incremental cost\u2010effectiveness ratio of 3100 international dollars per quality\u2010adjusted life\u2010year.<jats:styled-content style=\"fixed-case\">ECHO<\/jats:styled-content>\u2010based strategies resulted in cost and effectiveness almost identical to<jats:styled-content style=\"fixed-case\">CTA<\/jats:styled-content>, and<jats:styled-content style=\"fixed-case\">SPECT<\/jats:styled-content>\u2010based strategies were dominated because of their much higher cost. Strategies based on stress C\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>were most effective, but the incremental cost\u2010effectiveness ratio vs<jats:styled-content style=\"fixed-case\">CTA<\/jats:styled-content>was higher than the proposed willingness\u2010to\u2010pay threshold. Invasive strategies were dominant in the high pretest probability setting. Sensitivity analysis showed that results were sensitive to costs of<jats:styled-content style=\"fixed-case\">CTA<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\">ECHO<\/jats:styled-content>, and C\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>. Coronary<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>is cost\u2010effective for the diagnosis of coronary artery disease and should be included in the Brazilian public health system. Stress<jats:styled-content style=\"fixed-case\">ECHO<\/jats:styled-content>has a similar performance and is an acceptable alternative for most patients, but invasive strategies should be reserved for patients at high risk.<\/jats:p>","DOI":"10.1002\/clc.22532","type":"journal-article","created":{"date-parts":[[2016,4,15]],"date-time":"2016-04-15T11:29:18Z","timestamp":1460719758000},"page":"249-256","source":"Crossref","is-referenced-by-count":21,"title":["Long\u2010term Cost\u2010Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-0348","authenticated-orcid":false,"given":"Eduardo G.","family":"Bertoldi","sequence":"first","affiliation":[{"name":"Internal Medicine Division Federal University of Pelotas Pelotas Brazil"},{"name":"Institute of Health Technology Assessment Porto Alegre Brazil"},{"name":"Graduate Program in Cardiology Federal University of Rio Grande do Sul Porto Alegre Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffan F.","family":"Stella","sequence":"additional","affiliation":[{"name":"Institute of Health Technology Assessment Porto Alegre Brazil"},{"name":"Graduate Program in Cardiology Federal University of Rio Grande do Sul Porto Alegre Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis E.","family":"Rohde","sequence":"additional","affiliation":[{"name":"Graduate Program in Cardiology Federal University of Rio Grande do Sul Porto Alegre Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carisi A.","family":"Polanczyk","sequence":"additional","affiliation":[{"name":"Institute of Health Technology Assessment Porto Alegre Brazil"},{"name":"Graduate Program in Cardiology Federal University of Rio Grande do Sul Porto Alegre Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,4,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318277d6a0"},{"key":"e_1_2_6_3_1","volume-title":"Relative Cost\u2010Effectiveness of Five Non\u2010invasive Cardiac Imaging Technologies for Diagnosing Coronary Artery Disease in Ontario","author":"Toronto Health Economics and Technology Assessment (THETA)"},{"key":"e_1_2_6_4_1","volume-title":"Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin","author":"Cooper A","year":"2010"},{"key":"e_1_2_6_5_1","unstructured":"Minist\u00e9rio da Sa\u00fade do Brasil. 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