• J Nucl Cardiol · May 2003

    Comparative Study

    A comprehensive strategy for the evaluation and triage of the chest pain patient: a cost comparison study.

    • Michael C Kontos, Kristin L Schmidt, Michael McCue, Louis F Rossiter, Michael Jurgensen, Christopher S Nicholson, Robert L Jesse, Joseph P Ornato, and James L Tatum.
    • Department of Radiology, Virginia Commonwealth University, Medical College of Virginia Hospital and Physicians of the Virginia Commonwealth, University Health Systems, Richmond, VA 23298-0051, USA. mkontos@hsc.vcu.edu
    • J Nucl Cardiol. 2003 May 1;10(3):284-90.

    BackgroundOur objective was to determine the cost-effectiveness of a comprehensive, risk-based triage system, composed of multiple critical pathways, with the use of early myocardial perfusion imaging (MPI) in low-risk patients. We found previously that a chest pain evaluation system that uses MPI in low-risk patients was safe and effective, but the cost-effectiveness of this approach was not studied.Methods And ResultsWe compared two groups. The Acute Cardiac Team (ACT) group (n = 874) was assigned prospectively to 1 of 4 risk levels by emergency department (ED) physicians. Level 1, 2, and 3 patients were admitted; level 4 patients were evaluated in the ED. Level 3 and 4 patients underwent ED MPI. The control group (n = 713) represented consecutive patients evaluated in the prior year according to standard care and assigned retrospectively to an ACT level based on the presenting electrocardiographic and clinical data. Record and hospital administrative data were assessed for clinical variables, outcomes, lengths of stay, and all expenses incurred within 30 days of the index visit. The baseline characteristics of the two groups were similar, including age, sex, myocardial infarction prevalence, and 30-day revascularization rates within each level or between the two groups. Mean costs per encounter were reduced for the ACT patients for each level, which was significant when all patients were compared ($5,030 +/- $7,081 vs $6,044 +/- $10,432, P =.02). Use of MPI in the low-risk patients was associated with reduced costs (level 3, $4,958 +/- $4,948 vs $5,051 +/- $7,036; level 4, $1,529 +/- $2,664 vs $1,794 +/- $6,854) and was associated with a significantly lower angiography rate and shorter length of stay.ConclusionsImplementation of a comprehensive strategy for chest pain evaluation and triage reduced overall costs for patients with chest pain on presentation. Acute MPI in the ED setting did not increase net cost.

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