title: Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission.
abstract: We conducted a cost-effectiveness analysis to examine the clinical and economic consequences of alternatives to admission to a coronary-care unit for patients who have a relatively low probability of acute myocardial infarction. Despite the fact that all our assumptions were slanted to favor the current standard policy of admission to a coronary-care unit, our analysis shows that admission to an intermediate-care unit providing resuscitative facilities and prophylactic lidocaine is highly cost effective. For patients with about a 5 per cent probability of infarction, admission to a coronary-care unit would cost $2.04 million per life saved and $139,000 per year of life saved, as compared with intermediate care. For the expected number of such patients annually in the United States, the cost would be $297 million to save 145 lives. At probabilities of infarction up to about 20 per cent, the incremental cost to save a year of life by choosing a coronary-care unit over an intermediate-care unit would be higher than the estimated cost of saving a year of life by treating a 40-year-old man with mild hypertension. Our results suggest that many patients who have a low risk of acute myocardial infarction would be appropriate candidates for admission to an intermediate-care unit.
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D000787:Angina Pectoris / Q000628:therapy; D003325:Coronary Care Units / Q000191:economics*; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D006757:Hospital Units / Q000191:economics; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D011336:Probability; D012306:Risk; D014481:United States