BACKGROUND: Coronary computed tomographic angiography (cCTA) allows rapid, noninvasive exclusion of obstructive coronary artery disease (CAD). However, concern exists whether implementation of cCTA in the assessment of patients presenting to the emergency department with acute chest pain will lead to increased downstream testing and costs compared with alternative strategies. Our aim was to compare observed actual costs of usual care (UC) with projected costs of a strategy including early cCTA in the evaluation of patients with acute chest pain in the Rule Out Myocardial Infarction Using Computer Assisted Tomography I (ROMICAT I) study. METHODS AND RESULTS: We compared cost and hospital length of stay of UC observed among 368 patients enrolled in the ROMICAT I study with projected costs of management based on cCTA. Costs of UC were determined by an electronic cost accounting system. Notably, UC was not influenced by cCTA results because patients and caregivers were blinded to the cCTA results. Costs after early implementation of cCTA were estimated assuming changes in management based on cCTA findings of the presence and severity of CAD. Sensitivity analysis was used to test the influence of key variables on both outcomes and costs. We determined that in comparison with UC, cCTA-guided triage, whereby patients with no CAD are discharged, could reduce total hospital costs by 23% (P<0.001). However, when the prevalence of obstructive CAD increases, index hospitalization cost increases such that when the prevalence of ≥ 50% stenosis is >28% to 33%, the use of cCTA becomes more costly than UC. CONCLUSIONS: cCTA may be a cost-saving tool in acute chest pain populations that have a prevalence of potentially obstructive CAD <30%. However, increased cost would be anticipated in populations with higher prevalence of disease.
BACKGROUND: Coronary computed tomographic angiography (cCTA) allows rapid, noninvasive exclusion of obstructive coronary artery disease (CAD). However, concern exists whether implementation of cCTA in the assessment of patients presenting to the emergency department with acute chest pain will lead to increased downstream testing and costs compared with alternative strategies. Our aim was to compare observed actual costs of usual care (UC) with projected costs of a strategy including early cCTA in the evaluation of patients with acute chest pain in the Rule Out Myocardial Infarction Using Computer Assisted Tomography I (ROMICAT I) study. METHODS AND RESULTS: We compared cost and hospital length of stay of UC observed among 368 patients enrolled in the ROMICAT I study with projected costs of management based on cCTA. Costs of UC were determined by an electronic cost accounting system. Notably, UC was not influenced by cCTA results because patients and caregivers were blinded to the cCTA results. Costs after early implementation of cCTA were estimated assuming changes in management based on cCTA findings of the presence and severity of CAD. Sensitivity analysis was used to test the influence of key variables on both outcomes and costs. We determined that in comparison with UC, cCTA-guided triage, whereby patients with no CAD are discharged, could reduce total hospital costs by 23% (P<0.001). However, when the prevalence of obstructive CAD increases, index hospitalization cost increases such that when the prevalence of ≥ 50% stenosis is >28% to 33%, the use of cCTA becomes more costly than UC. CONCLUSIONS:cCTA may be a cost-saving tool in acute chest pain populations that have a prevalence of potentially obstructive CAD <30%. However, increased cost would be anticipated in populations with higher prevalence of disease.
Authors: Michael J Gallagher; Michael A Ross; Gilbert L Raff; James A Goldstein; William W O'Neill; Brian O'Neil Journal: Ann Emerg Med Date: 2006-09-15 Impact factor: 5.721
Authors: Christopher L Schlett; Dahlia Banerji; Emily Siegel; Fabian Bamberg; Sam J Lehman; Maros Ferencik; Thomas J Brady; John T Nagurney; Udo Hoffmann; Quynh A Truong Journal: JACC Cardiovasc Imaging Date: 2011-05
Authors: Udo Hoffmann; Antonio J Pena; Fabian Moselewski; Maros Ferencik; Suhny Abbara; Ricardo C Cury; Claudia U Chae; John T Nagurney Journal: AJR Am J Roentgenol Date: 2006-11 Impact factor: 3.959
Authors: James A Goldstein; Michael J Gallagher; William W O'Neill; Michael A Ross; Brian J O'Neil; Gilbert L Raff Journal: J Am Coll Cardiol Date: 2007-02-12 Impact factor: 24.094
Authors: Joanne D Schuijf; Jeroen J Bax; Leslee J Shaw; Albert de Roos; Hildo J Lamb; Ernst E van der Wall; William Wijns Journal: Am Heart J Date: 2006-02 Impact factor: 4.749
Authors: Ronen Rubinshtein; David A Halon; Tamar Gaspar; Ronen Jaffe; Jacob Goldstein; Basheer Karkabi; Moshe Y Flugelman; Asia Kogan; Reuma Shapira; Nathan Peled; Basil S Lewis Journal: Am J Cardiol Date: 2007-09-27 Impact factor: 2.778
Authors: Joseph A Ladapo; Udo Hoffmann; Fabian Bamberg; John T Nagurney; David M Cutler; Milton C Weinstein; G Scott Gazelle Journal: AJR Am J Roentgenol Date: 2008-08 Impact factor: 3.959
Authors: Kelley R Branch; Ryan D Haley; Marcio Sommer Bittencourt; Amit R Patel; Edward Hulten; Ron Blankstein Journal: Cardiovasc Diagn Ther Date: 2017-10
Authors: S Divakaran; M K Cheezum; E A Hulten; M S Bittencourt; M G Silverman; K Nasir; R Blankstein Journal: Br J Radiol Date: 2014-12-12 Impact factor: 3.039
Authors: Dustin M Thomas; Sanjay Divakaran; Todd C Villines; Khurram Nasir; Nishant R Shah; Ahmad M Slim; Ron Blankstein; Michael K Cheezum Journal: Curr Cardiovasc Imaging Rep Date: 2015
Authors: Giuseppe Muscogiuri; Marly Van Assen; Christian Tesche; Carlo N De Cecco; Mattia Chiesa; Stefano Scafuri; Marco Guglielmo; Andrea Baggiano; Laura Fusini; Andrea I Guaricci; Mark G Rabbat; Gianluca Pontone Journal: Biomed Res Int Date: 2020-12-16 Impact factor: 3.411
Authors: Alexandre de Matos Soeiro; Bruno Biselli; Tatiana C A T Leal; Aline Siqueira Bossa; Maria Cristina César; Sérgio Jallad; Priscila Gherardi Goldstein; Patrícia Oliveira Guimarães; Carlos Vicente Serrano; Cesar Higa Nomura; Débora Nakamura; Carlos Eduardo Rochitte; Paulo Rogério Soares; Múcio Tavares de Oliveira Journal: Arq Bras Cardiol Date: 2022-05 Impact factor: 2.667