HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ladapo, J. A. Articles by Gazelle, G. S. Search for Related Content PubMed PubMed Citation Articles by Ladapo, J. A. Articles by Gazelle, G. S. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Cost-Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain

¹ Harvard Ph.D. Program in Health Policy, 14 Story St., 4th Floor, Cambridge, MA 02138.
² Department of Radiology, Massachusetts General Hospital, Boston, MA.
³ Harvard Medical School, Boston, MA.
⁴ Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
⁵ Department of Economics, Harvard University, Cambridge, MA.
⁶ National Bureau of Economic Research, Cambridge, MA.
⁷ Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
⁸ Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.

OBJECTIVE. Patients at low risk for acute coronary syndrome (ACS) who present to the emergency department complaining of acute chest pain place a substantial economic burden on the U.S. health care system. Noninvasive 64-MDCT coronary angiography may facilitate their triage, and we evaluated its cost-effectiveness.

MATERIALS AND METHODS. A microsimulation model was developed to compare costs and health effects of performing CT coronary angiography and either discharging, stress testing, or referring emergency department patients for invasive coronary angiography, depending on their severity of atherosclerosis, compared with a standard-of-care (SOC) algorithm that based management on biomarkers and stress tests alone.

RESULTS. Using CT coronary angiography to triage 55-year-old men with acute chest pain increased emergency department and hospital costs by $110 and raised total health care costs by $200. In 55-year-old women, the technology was cost-saving; emergency department and hospital costs decreased by $410, and total health care costs decreased by $380. Compared with the SOC, CT coronary angiography-based triage extended life expectancy by 10 days in men and by 6 days in women. This translated into corresponding improvements of 0.03 quality-adjusted life years (QALYs) and 0.01 QALYs, respectively. The incremental cost-effectiveness ratio for CT coronary angiography was $6,400 per QALY in men; in women, CT coronary angiography was cost-saving. Cost-effectiveness ratios were sensitive to several parameters but generally remained in the range of what is typically considered cost-effective.

CONCLUSION. CT coronary angiography-based triage for patients with low-risk chest pain is modestly more effective than the SOC. It is also cost-saving in women and associated with low cost-effectiveness ratios in men.

Keywords: acute chest pain • cardiac CT • cost-effectiveness • health policy • noninvasive angiography

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf CT of Coronary Artery Disease Radiology, November 1, 2009; 253(2): 317 - 338. [Abstract] [Full Text] [PDF]

				J. A. Ladapo, J. R. Horwitz, M. C. Weinstein, G. S. Gazelle, and D. M. Cutler Adoption And Spread Of New Imaging Technology: A Case Study Health Aff., November 1, 2009; 28(6): w1122 - w1132. [Abstract] [Full Text] [PDF]

				T. S. S. Genders, W. B. Meijboom, M. F. L. Meijs, J. D. Schuijf, N. R. Mollet, A. C. Weustink, F. Pugliese, J. J. Bax, M. J. Cramer, G. P. Krestin, et al. CT Coronary Angiography in Patients Suspected of Having Coronary Artery Disease: Decision Making from Various Perspectives in the Face of Uncertainty Radiology, October 28, 2009; (2009) radiol.2533090507v1. [Abstract] [Full Text]

				G. Bastarrika, C. Thilo, G. F. Headden, P. L. Zwerner, P. Costello, and U. J. Schoepf Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department Am. J. Roentgenol., August 1, 2009; 193(2): 397 - 409. [Abstract] [Full Text] [PDF]

				E. J. Halpern Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome Radiology, August 1, 2009; 252(2): 332 - 345. [Abstract] [Full Text] [PDF]

				J. M. May, W. P. Shuman, J. N. Strote, K. R. Branch, L. M. Mitsumori, D. W. Lockhart, and J. H. Caldwell Low-Risk Patients With Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges Am. J. Roentgenol., July 1, 2009; 193(1): 150 - 154. [Abstract] [Full Text] [PDF]

				A. C. McCulloch, S. Paulin, S. K. Gerard, G. Karthikeyan, G. Vorobiof, W. M. Fogarty Jr., J. A.C. Lima, J. M. Miller, the CORE 64 Investigators, J. Walsh, et al. Coronary Angiography by 64-Row CT N. Engl. J. Med., May 7, 2009; 360(19): 2027 - 2031. [Full Text] [PDF]

				U. Hoffmann and F. Bamberg Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department Circ Cardiovasc Imaging, May 1, 2009; 2(3): 251 - 263. [Full Text] [PDF]

				R. C. Hendel Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department: Antagonist Viewpoint Circ Cardiovasc Imaging, May 1, 2009; 2(3): 264 - 275. [Full Text] [PDF]