title: Cost-effectiveness of telemetry for hospitalized patients with low-risk chest pain.
abstract: BACKGROUND
  The majority of chest pain admissions originate in the emergency department (ED). Despite a low incidence of cardiac events, limited telemetry availability, and its questionable benefit, these patients are routinely admitted to a monitored setting.
  
  
  OBJECTIVE
  The objectives were to analyze the cost-effectiveness of admission to telemetry versus admission to an unmonitored hospital bed in low-risk chest pain patients and explore when the use of telemetry may be cost-effective.
  
  
  METHODS
  The authors constructed a decision analytic model to evaluate the scenario of an ED admission of an otherwise healthy 55-year-old patient with low-risk chest pain defined as an acute coronary syndrome (ACS) probability of 2%. Costs were estimated from 2009 Medicare data for hospital reimbursement and physician services, as well as published data on disability costs. Published studies were used to estimate the risk of ACS, cardiac arrest, time to defibrillation, survival, long-term disability, and quality of life.
  
  
  RESULTS
  In the base case, telemetry was more effective (0.0044 quality-adjusted life-years [QALYs]) but more costly ($299.67) than a floor bed, resulting in a high marginal cost-effectiveness ratio (mCER) of $67,484.55 per QALY. In comprehensive sensitivity analyses, the mCER crossed below the willingness-to-pay (WTP) threshold of $50,000 per QALY when the following scenarios were met: the probability of ACS exceeds 3%, the probability of cardiac arrest is greater than 0.4%, the probability of shockable dysrhythmia is above 83%, the probability of delay in telemetry bed availability is below 52%, and the opportunity cost of delay to telemetry bed placement is below $119.
  
  
  CONCLUSIONS
  Telemetry may be a "cost-effective" use of health care resources for chest pain patients when patients have a probability of ACS above 3% or for patients with a minimal delay and cost associated with obtaining a monitored bed. Further research is needed to better stratify low-risk chest pain patients to the appropriate inpatient setting and to understand the frequency and costs associated with delays in obtaining monitored beds.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA. wardmj@uc.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ward
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.forename: Sean
authors.initials: S
authors.lastname: Collins
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality; D002637:Chest Pain / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004185:Disability Evaluation; D004636:Emergency Service, Hospital; D017721:Hospital Costs; D006801:Humans; D010343:Patient Admission; D011336:Probability; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D013686:Telemetry / Q000191:economics*