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Published on: August 9, 2024
Cost Impact of a Coronary Computed Tomography Angiography-Based Diagnostic Pathway for Low-Risk Chest Pain in the
Ryan Karlsson1, Michael Cronin1, Niall Sheehy2
1Department of Cardiology, St James's Hospital, D08 NHY1 Dublin, Ireland.
Insights
An accelerated outpatient coronary computed tomography angiography (CCTA) pathway significantly reduces diagnostic costs for low-risk chest pain patients in the emergency department (ED). This approach lowers healthcare expenses and hospital utilization without compromising short-term safety.
Area of Science:
- Cardiology
- Radiology
- Health Economics
Background:
- Emergency chest pain presentations are a significant healthcare burden.
- Coronary computed tomography angiography (CCTA) is safe and cost-effective for stable outpatients.
- The HEART score aids in risk-stratifying patients with undifferentiated chest pain.
Purpose of the Study:
- To evaluate the cost impact of an accelerated outpatient CCTA pathway versus inpatient invasive coronary angiography (ICA).
- To assess the diagnostic pathway for acute chest pain patients in the emergency department (ED) at a tertiary center.
Main Methods:
- Comparative cost analysis using retrospective observational data from 2023.
- Inclusion of stable adult ED patients presenting with chest pain.
Main Results:
- Outpatient CCTA (369 patients) vs. inpatient ICA (376 patients).
- CCTA pathway reduced diagnostic costs by 78% (€2990 per patient) for lower-risk individuals.
- No increase in 30-day mortality or myocardial infarction with CCTA.
- Shorter median length-of-stay for outpatient CCTA (6.5 hours) vs. inpatient ICA (5 days).
Conclusions:
- Accelerated outpatient CCTA pathway for low-risk ED chest pain patients offers substantial cost savings.
- Reduced hospital utilization observed with the CCTA pathway.
- No evidence of compromised short-term safety with the CCTA-based diagnostic approach.
Background:
Emergency chest pain presentations represent a substantial burden on healthcare resources. The use of coronary computed tomography angiography (CCTA) has been shown to be safe and associated with reduced costs in stable outpatients referred for invasive coronary angiography (ICA). The history, electrocardiogram, age, risk factors, troponin (HEART) risk assessment score is used to risk-stratify patients with undifferentiated chest pain. We sought to evaluate the cost impact of an accelerated outpatient CCTA-based diagnostic pathway compared with inpatient ICA for the investigation of patients presenting acutely to the emergency department (ED) with symptoms suggestive of coronary artery disease (CAD) at a tertiary referral centre.
Methods:
We performed a comparative cost analysis based on retrospective observational data including stable adult ED patients who presented in 2023.
Results:
369 patients underwent outpatient CCTA and 376 were admitted for ICA. The median time to outpatient CCTA was 14 days (interquartile range (IQR) 5-24). Use of the CCTA-based pathway was associated with a 78% reduction in diagnostic pathway costs (€2990 per patient), when compared to admission for ICA, for the investigation of lower-risk individuals, with no increase in 30-day mortality or myocardial infarction. Patients referred for outpatient CCTA had a significantly shorter median length-of-stay compared with those admitted for ICA (6.5 hours (IQR 5.0-9.0) vs. 5 days (IQR 3.0-14.9); p < 0.05).
Conclusions:
Use of an accelerated outpatient CCTA-based diagnostic pathway for low-risk chest pain patients in the ED was associated with substantial cost savings and reduced hospital utilization without evidence of compromised short-term safety.
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