Diego Perez de Arenaza, Abstract Co-Author: Nothing to Disclose

Fernando Andres Abramzon MD, Abstract Co-Author: Nothing to Disclose

Mariano Sturla MD, Abstract Co-Author: Nothing to Disclose

Mariano Falconi MD, Abstract Co-Author: Nothing to Disclose

Arturo Cagide MD, Abstract Co-Author: Nothing to Disclose

Ricardo D. Garcia-Monaco MD, Presenter: Nothing to Disclose

Jose Navarro Estrada MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Multidetector coronary CT angiography (MDCT) has shown to accurately rule out significant coronary disease (CAD) in low risk patients presenting with chest pain at the emergency department (ED) compared to standard diagnostic management. However, the overall cost-effectiveness of this strategy remains undefined.

We perform an economic evaluation, using decision analytic modelling, to asses the cost effectiveness of a strategy using a 64-slice MDCT compared to standard management in a chest pain unit (CPU) for diagnosing CAD in patients with acute chest pain presenting to the ED. Data for the standard management was obtained from our prospective registry (ITALSIA) of patients hospitalized with acute coronary syndromes (ACS). Clinical outcomes, resource use, and costs were assessed over a 1-year follow-up period. Prevalence of CAD was 32% and the average length of stay at the CPU 2.4 (± 2.35) days. Data for the MSCT strategy was obtained from literature showing sensitivity and specificity values up to 96% and 95% for diagnosing significant CAD. The analysis perspective was the payer.

Between 2004 and 2006, 1050 patients were evaluated for chest pain and suspected ACS. 136 were in the low risk AHA group (negative ECG and biomarkers) and admitted to the CPU, underwent coronary angiogram (33%), stress test (35%) or were discharge (32%). Over the follow-up period, none of them died, one was re-hospitalized for ACS, one required coronary angioplasty and one bypass surgery. The average cost per CAD diagnosis was 2582 US$ in the MDCT strategy compared to 3796 US$ with the standard management . If MDCT dominated the decision making strategy the rate of hospitalization was reduced by 68%. In a sensitivity analysis, varying the cost of MSCT scan from 500 to 900 US$ did not modify these results.

In this model, MDCT strategy was cost-saving compared to a standard management.

MSCT may be useful for diagnosing CAD in low risk patients with acute chest pain, reducing unnecessary hospitalizations and healthcare system costs.

Perez de Arenaza, D, Abramzon, F, Sturla, M, Falconi, M, Cagide, A, Garcia-Monaco, R, Navarro Estrada, J, et al, , et al, , Cost-effectiveness of 64-multidetector Coronary CT Angiography Compared to Standard Management in Low Risk Patients with Acute Chest Pain.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5005662.html