title: Acute nontraumatic chest pain in emergency department and cost-effectiveness evaluation.
abstract: OBJECTIVE
  Cost-effective use of cardiac markers for the evaluation of ischemic chest pain (CP) patients at the emergency department (ED) is attracting the attention of researchers. The aim of this study is to define how cost-effective an approach should be for evaluate CP patients and to evaluate whether testing for cardiac markers is done cost-effectively in CP patients.
  
  
  METHODS
  In this retrospective study, 1028 ischemic CP patients (aged from 17-89 years, 389 female, 639 male) with non-diagnostic electrocardiography (ECG) who were admitted to the ED between September 2002 and September 2003 were enrolled into the study.
  
  
  RESULTS
  The conditions of how diagnostic tests were actually ordered for these patients and how they should have been ordered cost-effectively were assessed and both the cost and effectiveness were compared. The actual total cost of the diagnostic tests ordered to investigate ischemic CP was $42,476. The cost would have been $32,342 if they had been ordered in the most cost-effective manner, for a total savings of $10,134. The ED cost, the calculated cost-effective cost and the lost amount were compared with the Student's t-test, and the differences between them was found to be statistically significant (p<0.001). The effectiveness was compared using the chi-square test and was found to be significant (χ(2)= 12.20, SD= 1, p<0.001).
  
  
  CONCLUSIONS
  In conclusion, fast and effective evaluation of ischemic CP in the ED and correct management of patients by correct determination of the risk factors provides a high level of cost-effectiveness. Every ED should determine an algorithm for patients admitted with CP and physicians should obey this algorithm.
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Emergency Medicine, Erzurum, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Cakir
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Emergency Medicine, Erzurum, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Saritas
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Emergency Medicine, Erzurum, Turkey.
authors.forename: Sahin
authors.initials: S
authors.lastname: Aslan
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Emergency Medicine, Erzurum, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Emet
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Emergency Medicine, Erzurum, Turkey.
authors.forename: Hayati
authors.initials: H
authors.lastname: Kandis
keywords: Cardiac markers; Chest pain; Cost-effectiveness; Emergency department