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Cost-Effectiveness of the CADScor System in Low-Risk Patients Presenting to the Emergency Department with Chest Pain
Suzanne J Baron1,2, Serge Korjian3,4, C Michael Gibson3,4
1Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. sbaron@mgb.org.
Insights
The CADScor System offers a cost-effective approach for evaluating low-risk chest pain in emergency departments, potentially saving millions for the US healthcare system. This strategy reduces costs without significantly impacting adverse events.
Area of Science:
- Cardiology
- Health Economics
- Medical Device Evaluation
Background:
- Up to 13% of emergency department patients with low-risk chest pain undergo unnecessary cardiac testing.
- The CADScor System, FDA-cleared, uses phonocardiography to assess coronary artery disease (CAD) risk.
Purpose of the Study:
- To evaluate the cost-effectiveness of the CADScor System versus other diagnostic methods for low-risk chest pain in US emergency departments.
Main Methods:
- A decision analytic tree and Markov model compared 1-year costs and outcomes.
- Model inputs were literature-derived; costs used US reimbursement data (2023 USD).
- Sensitivity analyses assessed parameter uncertainty.
Main Results:
- A CADScor-First strategy was cost-saving compared to other noninvasive tests.
- No substantial difference in adverse events was observed.
- Estimated cost savings range from $7.3-15.3 million USD per 10,000 patients.
Conclusions:
- A CADScor-First strategy may yield significant cost savings for the US healthcare system in evaluating low-risk chest pain.
- Further research is needed on long-term costs and outcomes.
Background:
Studies have shown that up to 13% of patients presenting to the emergency department (ED) with low-risk chest pain receive further cardiac testing beyond an electrocardiogram and serial cardiac enzymes. The CADScor System is a US Food and Drug Administration (FDA)-cleared device that uses ultra-sensitive phonocardiography to evaluate the risk of significant coronary artery disease (CAD).
Objective:
To evaluate the relative cost-effectiveness of the CADScor system compared with other diagnostic modalities for the evaluation of low-risk chest pain in patients presenting to the ED in the USA.
Methods:
A two-part economic model, consisting of a decision analytic tree followed by a short-term Markov model, was developed to compare 1-year costs and outcomes (e.g., quality-adjusted life year [QALY], false-negatives, and related cardiac events) associated with the CADScor System as the first-line test versus other noninvasive cardiac tests from the perspective of the US healthcare system (TreeAge Pro). Model inputs were derived from literature, and costs for treatment strategies were calculated from average US reimbursements associated with Current Procedural Terminology and Medicare Severity Diagnosis Related Group codes. Values were reported in 2023 US dollars (USD). Parameter uncertainty was assessed through a series of deterministic and one-way sensitivity analyses.
Results:
Base case results demonstrated that a CADScor-First strategy was cost saving compared with other noninvasive cardiac tests without a substantial difference in adverse events. Economic results were consistent when coronary artery disease (CAD) prevalence rates were varied from 2 to 30% and across a variety of sensitivity analyses. The overall cost savings were estimated to be $7.3-15.3 million USD per 10,000 patients with low-risk chest pain.
Conclusions:
Use of a CADScor-First strategy in the evaluation of patients with low-risk chest pain presenting to the ED may result in substantial cost savings for the US healthcare system. More research is needed to understand the long-term costs and outcomes of this strategy.
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