Triage With CCTA Appears More Effective
A study completed by a team from the Harvard Program in Health Policy indicates that coronary CT angiography (CCTA) is at least as effective as the current standard of care to assess low risk patients who present to the emergency room with chest pain. Findings also suggest that this is a less expensive evaluation in women and has cost saving benefits in men.
The study was initially completed to determine the cost burden of care for patients who are at low risk for developing acute coronary syndrome (ACS) on the healthcare system. This was investigated using a microsimulation model that compared health effects and costs. The model evaluated factors based on an algorithm of standard of care. Management for patients was determined by stress tests and biomarkers alone.
The team considered a variety of different scenarios. That included, for all patients, completion of CCTA. This was followed by one of three different options: stress testing, referring patients for invasive coronary angiography, or discharge. They also evaluated quality-adjusted life years (QALYs) as an additional outcome.
The team found that utilization of CCTA for a woman with chest pain in the ER yielded cost savings; costs for the hospital stay and ER decreased by $410 and overall healthcare costs decreased by $380. Triage with CCTA improved the life expectancy for women, on average, six days. This translated to 0.01 QALYs.
There was a moderate increase in costs for men who underwent treatment in the same manner. Total healthcare costs increased by $200 and $110 for the hospitalization and ER. The improvement to QALYs was more significant for men compared to women; it increased by ten days, on average.
Another outcome related to QALYs is cost-effectiveness associated with CCTA. For men, the technology was noted to be cost-effective; the ratio was $6,400 per QALY. Among women, the approach was actually cost-savings.
August 8, 2008 Related topics: Imaging, Diagnostic, Cardiology