title: Stress CMR imaging observation unit in the emergency department reduces 1-year medical care costs in patients with acute chest pain: a randomized study for comparison with inpatient care.
abstract: OBJECTIVE
  This study sought to compare the direct cost of medical care and clinical events during the first year after patients with intermediate risk acute chest pain were randomized to stress cardiac magnetic resonance (CMR) observation unit (OU) testing versus inpatient care.
  
  
  BACKGROUND
  In a recent study, randomization to OU-CMR reduced median index hospitalization cost compared with the cost of inpatient care in patients presenting to the emergency department with intermediate risk acute chest pain.
  
  
  METHODS
  Emergency department patients with intermediate risk chest pain were randomized to OU-CMR (OU care, cardiac markers, stress CMR) or inpatient care (admission, care per admitting provider). This analysis reports the direct cost of cardiac-related care and clinical outcomes (myocardial infarction, revascularization, cardiovascular death) during the first year of follow-up subsequent to discharge. Consistent with health economics literature, provider cost was calculated from work-related relative value units using the Medicare conversion factor; facility charges were converted to cost using departmental-specific cost-to-charge ratios. Linear models were used to compare cost accumulation among study groups.
  
  
  RESULTS
  We included 109 randomized subjects in this analysis (52 OU-CMR, 57 inpatient care). The median age was 56 years; baseline characteristics were similar in both groups. At 1 year, 6% of OU-CMR and 9% of inpatient care participants experienced a major cardiac event (p = 0.72) with 1 patient in each group experiencing a cardiac event after discharge. First-year cardiac-related costs were significantly lower for participants randomized to OU-CMR than for participants receiving inpatient care (geometric mean = $3,101 vs. $4,742 including the index visit [p = 0.004] and $29 vs. $152 following discharge [p = 0.012]). During the year following randomization, 6% of OU-CMR and 9% of inpatient care participants experienced a major cardiac event (p = 0.72).
  
  
  CONCLUSIONS
  An OU-CMR strategy reduces cardiac-related costs of medical care during the index visit and over the first year subsequent to discharge, without an observed increase in major cardiac events. (Cost Comparison of Cardiac Magnetic Resonance Imaging [MRI] Use in Emergency Department [ED] Patients With Chest Pain; NCT00678639).
authors.affiliation: Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27357, USA. cmiller@wfubmc.edu
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.forename: Wenke
authors.initials: W
authors.lastname: Hwang
authors.forename: Doug
authors.initials: D
authors.lastname: Case
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
authors.forename: Cedric
authors.initials: C
authors.lastname: Lefebvre
authors.forename: Howard
authors.initials: H
authors.lastname: Blumstein
authors.forename: Craig A
authors.initials: CA
authors.lastname: Hamilton
authors.forename: Erin N
authors.initials: EN
authors.lastname: Harper
authors.forename: W Gregory
authors.initials: WG
authors.lastname: Hundley
mesh_terms: D000208:Acute Disease; D000241:Adenosine / Q000191:economics; D002637:Chest Pain / Q000175:diagnosis* / Q000191:economics* / Q000209:etiology / Q000628:therapy; D017046:Cost Savings; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D004280:Dobutamine / Q000191:economics; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D017721:Hospital Costs; D006801:Humans; D007297:Inpatients; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009657:North Carolina; D010343:Patient Admission / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D011237:Predictive Value of Tests; D013997:Time Factors
chemical_list: D004280:Dobutamine; D000241:Adenosine