Cardiac CT (CCT) in the emergency department (ED) is more cost effective in evaluating patients with suspected acute coronary syndrome (ACS) than the standard of care involving multiple tests and a stress SPECT scan, even when the downstream costs of CCT are considered, according to a study published in the March issue of Academic Radiology.
Chest pain accounts for 5 percent of all US ED visits, with approximately $12 billion spent on the evaluation of acute chest pain in 2008. Kelley R. Branch, MD, of the division of cardiology at the University of Washington in Seattle, and colleagues noted that these costs could be reduced if electrocardiogram-gated thoracic CT were used in place of the standard of care (SOC).
To test the cost-effectiveness of CCT, while accounting for downstream costs such as iodinated contrast complications or incidental, noncardiac CT findings, the researchers constructed a decision analytic cost-minimization model. Using data from a cohort study of 102 patients at low to intermediate risk for ACS who underwent an emergency department SOC clinical evaluation and a 64-channel CCT, they compared CCT-based and SOC evaluation costs to obtain a correct diagnosis.
Results showed that CCT-based evaluation of patients was 24 percent less expensive at one year, with mean CCT and SOC costs of $2,384 and $3,134, respectively. There were no expected differences in health outcomes.