Economic Outcome of Cardiac CT-Based Evaluation and Standard of Care for Suspected Acute Coronary Syndrome in the Emergency Department: A Decision Analytic Model

Branch, Kelley R.; Bresnahan, Brian W.; Veenstra, David L.; Shuman, William P.; Weintraub, William S.; Busey, Janet M.; Elliott, Daniel J.; Mitsumori, Lee M.; Strote, Jared; Jobe, Kathleen; Dubinsky, Ted; Caldwell, James H.

doi:10.1016/j.acra.2011.10.029

« Previous Next »Academic Radiology
Volume 19, Issue 3 , Pages 265-273, March 2012

Economic Outcome of Cardiac CT-Based Evaluation and Standard of Care for Suspected Acute Coronary Syndrome in the Emergency Department:

A Decision Analytic Model

Kelley R. Branch, MD, MS
- Division of Cardiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
- Address correspondence to: K.R.B.
Brian W. Bresnahan, PhD
- Department of Radiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
David L. Veenstra, PharmD, PhD
- Department of Pharmacy, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
William P. Shuman, MD
- Department of Radiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
William S. Weintraub, MD
- Division of Cardiology and Internal Medicine, Christiana Care Health System, Newark, DE
Janet M. Busey, MS
- Department of Radiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
Daniel J. Elliott, MD, MSCE
- Division of Cardiology and Internal Medicine, Christiana Care Health System, Newark, DE
Lee M. Mitsumori, MD
- Department of Radiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
Jared Strote, MD
- Department of Emergency Medicine, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
Kathleen Jobe, MD
- Department of Emergency Medicine, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
Ted Dubinsky, MD
- Department of Radiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
James H. Caldwell, MD
- Division of Cardiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195
- Department of Radiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195

Received 6 June 2011; accepted 24 October 2011. published online 03 January 2012.

Rationale and Objectives

Cardiac computed tomography (CCT) in the emergency department may be cost saving for suspected acute coronary syndrome (ACS), but economic outcome data are limited. The objective of this study was to compare the cost of CCT-based evaluation versus standard of care (SOC) using the results of a clinical trial.

Materials and Methods

We developed a decision analytic cost-minimization model to compare CCT-based and SOC evaluation costs to obtain a correct diagnosis. Model inputs, including Medicare-adjusted patient costs, were primarily obtained 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. SOC costs included stress testing in 77% of patients. Data from published literature completed the model inputs and expanded data ranges for sensitivity analyses.

Results

Modeled mean patient costs for CCT-based evaluation were $750 (24%) lower than the SOC ($2384 and $3134, respectively). Sensitivity analyses indicated that CCT was less expensive over a wide range of estimates and was only more expensive with a CCT specificity below 67% or if more than 44% of very low risk patients had CCT. Probabilistic sensitivity analysis suggested that CCT-based evaluation had a 98.9% probability of being less expensive compared to SOC.

Conclusion

Using a decision analytic model, CCT-based evaluation resulted in overall lower cost than the SOC for possible ACS patients over a wide range of cost and outcome assumptions, including computed tomography–related complications and downstream costs.

Key Words: Cost-benefit analysis, computed tomography, acute coronary syndrome, emergency department

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This publication was made possible, in part, by 1. Grant Number 5KL2RR025015-02 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.

2. GE Healthcare.

PII: S1076-6332(11)00518-6

doi:10.1016/j.acra.2011.10.029

« Previous Next »Academic Radiology
Volume 19, Issue 3 , Pages 265-273, March 2012

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