title: Cost-efficiency of myocardial contrast echocardiography in patients presenting to the emergency department with chest pain of suspected cardiac origin and a nondiagnostic electrocardiogram.
abstract: Assessment of patients presenting to the emergency department (ED) with suspected cardiac chest pain and a nondiagnostic electrocardiogram (ECG) is lengthy and costly. It was hypothesized that myocardial contrast echocardiography (MCE) can be cost-efficient in such patients by detecting those with chest pain that is noncardiac in nature. Accordingly, cost-efficiency was evaluated in 957 patients presenting to the ED with suspected cardiac chest pain, but no ST-segment elevation on the ECG, who underwent MCE. Economic outcome calculations were based on costs estimated from national average Medicare charges adjusted by a cost-charge ratio. Based on routine clinical criteria, 641 patients (67%) were admitted to the hospital, whereas 316 (33%) were discharged directly from the ED. The average cost per patient using routine evaluation was $5,000. Patients with normal MCE results (n = 523) had a very low primary event rate (death, acute myocardial infarction) of 0.6% within 24 hours after presentation, making it relatively safe to discharge patients directly from the ED with a normal MCE result. Hence, if MCE had been used for decision making, 523 patients (55%) would have been discharged directly from the ED and 434 (45%) would have been admitted to the hospital. Preventing unnecessary admissions and tests would have saved an average of $900 per patient, in addition to reducing their ED stay. In conclusion, by excluding cardiac causes in patients presenting to the ED with chest pain and a nondiagnostic ECG, MCE can prevent unnecessary admissions and downstream resource utilization, making it a cost-efficient tool in the evaluation of these patients.
authors.affiliation: Cardiovascular Division and Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Jared J
authors.initials: JJ
authors.lastname: Wyrick
authors.forename: Saul
authors.initials: S
authors.lastname: Kalvaitis
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.forename: Diana
authors.initials: D
authors.lastname: Rinkevich
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kaul
authors.forename: Kevin
authors.initials: K
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology*; D003287:Contrast Media / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004452:Echocardiography / Q000191:economics*; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D003287:Contrast Media
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