Economic Outcomes With Precision Diagnostic Testing Versus Usual Testing in Stable Chest Pain: Results From the...

Area of Science:

• Cardiology
• Medical Diagnostics
• Health Economics

Background:

• The Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization (PRECISE) investigated a precision diagnostic strategy for nonacute chest pain.
• This strategy aimed to improve clinical outcomes and evaluate medical costs compared to usual testing protocols.

Purpose of the Study:

• To assess the efficacy of a precision diagnostic strategy in reducing adverse cardiac events in patients with nonacute chest pain.
• To determine the impact of this precision strategy on healthcare costs from a US healthcare system perspective.

Main Methods:

• 2103 patients were randomized to either a precision strategy or usual testing.
• The precision strategy involved deferred testing for low-risk patients and coronary computed tomographic angiography with selective computed tomography-derived fractional flow reserve for others.
• Medical costs were tracked at 45 days and 12 months.

Main Results:

• The precision strategy reduced the primary composite endpoint by 65%.
• Total medical costs were similar between strategies at 45 days (mean difference $182) and at 12 months (mean difference $478, P=0.43).
• Precision care decreased diagnostic costs by 27% but increased revascularization costs by 67%.

Conclusions:

• The PRECISE precision strategy improved clinical efficiency for diagnosing cardiac symptoms.
• This risk-based approach, aligned with guidelines, resulted in comparable healthcare costs to usual testing.
• The precision strategy offers a clinically effective and economically similar alternative to standard diagnostic pathways.