title: Stress echocardiography in the district hospital setting: a cost-saving analysis.
abstract: OBJECTIVE
  Accurate and cost-effective techniques are required for investigating patients experiencing chest pain, given the significant workload this patient cohort represents. We determined the cost impact of stress echocardiography compared with myocardial perfusion scintigraphy and coronary angiography in the investigation of patients with chest pain deemed unsuitable for exercise treadmill testing.
  
  
  RESULTS
  A total of 200 patients with chest pain-with a low-intermediate probability of coronary artery disease-consecutively referred for stress echocardiography were recruited. Referring clinicians were asked which management strategy they would have chosen were the stress echocardiography service unavailable. The cost saving of stress echocardiography, an accuracy analysis, and adverse outcomes at 6 and 24 months follow-up were determined. The total cost attributable to the stress echocardiography service was Pound Sterling 58 368. If unavailable, 78 (39%) patients would have been referred for angiography and 122 (61%) for perfusion scintigraphy at a cost of Pound Sterling 56 316 and Pound Sterling 42 090, respectively, with a total cost of Pound Sterling 98 406. This represents a cost saving of Pound Sterling 40 038.
  
  
  CONCLUSIONS
  Stress echocardiography is a cost saving method for the investigation of chest pain in patients with low-intermediate risk of flow limiting coronary artery disease in the district hospital setting.
authors.affiliation: Department of Acute Medicine, Poole General Hospital, Longfleet Road, Poole, Dorset BH15 2JB, UK.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Wennike
authors.forename: Benoy Nalin
authors.initials: BN
authors.lastname: Shah
authors.forename: Emma
authors.initials: E
authors.lastname: Boger
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.forename: Kim
authors.initials: K
authors.lastname: Greaves
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D017023:Coronary Angiography / Q000191:economics*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D025401:Echocardiography, Stress / Q000191:economics*; D005080:Exercise Test; D005260:Female; D006767:Hospitals, District / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000191:economics*; D015425:Myocardial Reperfusion / Q000191:economics*; D012680:Sensitivity and Specificity; D006113:United Kingdom