title: Systematic Review of Economic Evaluations of Units Dedicated to Acute Coronary Syndromes.
abstract: BACKGROUND
  Dedicated units for the care of acute coronary syndrome (ACS) have been submitted to economic evaluations; however, the results have not been systematically presented.
  
  
  OBJECTIVE
  To identify and summarize economic outcomes of studies on hospital units dedicated to the initial care of patients with suspected or confirmed ACS.
  
  
  METHODS
  A systematic review of literature to identify economic evaluations of chest pain unit (CPU), coronary care unit (CCU), or equivalent units was done. Two search strategies were used: the first one to identify economic evaluations irrespective of study design, and the second one to identify randomized clinical trials that reported economic outcomes. The following databases were searched: MEDLINE, EMBASE, CENTRAL, and National Health Service (NHS)Economic Evaluation Database. Data extraction was performed by two independent reviewers. Costs were inflated to 2012 values.
  
  
  RESULTS
  Search strategies retrieved five partial economic evaluations based on observational studies, six randomized clinical trials that reported economic outcomes, and five model-based economic evaluations. Overall, cost estimates based on observational studies and randomized clinical trials reported statistically significant cost savings of more than 50% with the adoption of CPU care instead of routine hospitalization or CCU care for suspected low-to-intermediate risk patients with ACS (median per-patient cost US $1,969.89; range US $1,002.12-13,799.15). Model-based economic evaluations reported incremental cost-effectiveness ratios below US $ 50,000/quality-adjusted life-year for all comparisons between intermediate care unit, CPU, or CCU with routine hospital admissions. This finding was sensible to myocardial infarction probability.
  
  
  CONCLUSIONS
  Published economic evaluations indicate that more intensive care is likely to be cost-effective in comparison to routine hospital admission for patients with suspected ACS.
authors.affiliation: Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Porto Alegre Clinical Hospital, Porto Alegre, Brazil; National Institute for Health Technology Assessment (INCT/IATS-Brazil), Porto Alegre, Brazil. Electronic address: andre@htanalyze.com.
authors.forename: André Luis Ferreira
authors.initials: AL
authors.lastname: Azeredo-Da-Silva
authors.affiliation: Porto Alegre Clinical Hospital, Porto Alegre, Brazil.
authors.forename: Silvana
authors.initials: S
authors.lastname: Perini
authors.affiliation: Porto Alegre Clinical Hospital, Porto Alegre, Brazil.
authors.forename: Pedro Henrique
authors.initials: PH
authors.lastname: Rigotti Soares
authors.affiliation: Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; National Institute for Health Technology Assessment (INCT/IATS-Brazil), Porto Alegre, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Cardiovascular Division of Porto Alegre Hospital, Porto Alegre, Brazil.
authors.forename: Carisi Anne
authors.initials: CA
authors.lastname: Polaczyk
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D003325:Coronary Care Units / Q000191:economics* / Q000592:standards; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017721:Hospital Costs; D006801:Humans; D018803:Models, Economic; D010343:Patient Admission / Q000191:economics; D019984:Quality Indicators, Health Care; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
keywords: CCU; CPU; chest pain unit; coronary care unit; cost effectiveness; systematic review