Economic outcome of cardiac CT-based evaluation and standard of care for suspected acute coronary syndrome in the emergency department: a decision analytic model.
OBJECTIVE
Cardiac computed tomography (CCT) in the emergency department may be cost saving for suspected acute coronary syndrome (ACS), but economic outcome data are limited. The objective of this study was to compare the cost of CCT-based evaluation versus standard of care (SOC) using the results of a clinical trial.


METHODS
We developed a decision analytic cost-minimization model to compare CCT-based and SOC evaluation costs to obtain a correct diagnosis. Model inputs, including Medicare-adjusted patient costs, were primarily obtained from a cohort study of 102 patients at low to intermediate risk for ACS who underwent an emergency department SOC clinical evaluation and a 64-channel CCT. SOC costs included stress testing in 77% of patients. Data from published literature completed the model inputs and expanded data ranges for sensitivity analyses.


RESULTS
Modeled mean patient costs for CCT-based evaluation were $750 (24%) lower than the SOC ($2384 and $3134, respectively). Sensitivity analyses indicated that CCT was less expensive over a wide range of estimates and was only more expensive with a CCT specificity below 67% or if more than 44% of very low risk patients had CCT. Probabilistic sensitivity analysis suggested that CCT-based evaluation had a 98.9% probability of being less expensive compared to SOC.


CONCLUSIONS
Using a decision analytic model, CCT-based evaluation resulted in overall lower cost than the SOC for possible ACS patients over a wide range of cost and outcome assumptions, including computed tomography-related complications and downstream costs.
Division of Cardiology, University of Washington, Seattle, 98195, USA. kbranch@u.washington.edu
Kelley R
KR
Branch
Brian W
BW
Bresnahan
David L
DL
Veenstra
William P
WP
Shuman
William S
WS
Weintraub
Janet M
JM
Busey
Daniel J
DJ
Elliott
Lee M
LM
Mitsumori
Jared
J
Strote
Kathleen
K
Jobe
Ted
T
Dubinsky
James H
JH
Caldwell
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics* / Q000592:standards; D005260:Female; D017048:Health Care Costs / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D059039:Standard of Care / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology