Study shows cost-effectiveness of 64-slice CT scanner in emergency department chest pain patients

A recent study led by Rahul Khare, MD, emergency department physician and assistant director of operations at Northwestern Memorial Hospital, sought to determine the cost-effectiveness of utilizing a CT scanner to evaluate low-risk chest pain patients in the emergency room. The study results which are published in the July issue of Academic Emergency Medicine show that using a 64-slice CT scanner is more cost-effective than the current standard of care for evaluating and diagnosing this patient population, which includes an overnight stay in the observation unit and cardiac stress testing.

Chest pain is the most common emergency department complaint in patients 50 years and older, and has a variety of potential causes. A commonly missed and difficult to diagnose cause of chest pain is coronary artery disease. "When patients arrive to the emergency department with chest pain, my goal as an emergency physician is to identify any life threatening conditions and treat the patient promptly. Currently it is a challenge to identify chest pain patients with significant coronary artery disease in a timely and cost-effective manner," says Dr. Khare, who is also an Assistant Professor of Emergency Medicine at Northwestern University's Feinberg School of Medicine.

The 64-slice CT scanner is a relatively new technology and has shown to be very effective in diagnosing coronary artery disease. "Some have advocated the use of the CT scanner in the emergency department for low-risk chest pain patients as an alternative to stress testing. The CT scanner has the potential to become a first-line screening instrument, but before that happens, we have to evaluate whether or not the cost is associated with better patient outcomes," comments Dr. Khare.

Dr. Khare utilized a computer model with one standard patient, a 54-year old male, which is reflective of the average age and most prevalent gender of patients in the chest pain observation unit. The computer model looked at cost-effectiveness within three different risk categories; very low risk, low risk and moderate risk patients. It also evaluated the metric of quality-adjusted life years (QALYs), since failure to detect coronary artery disease can reduce life expectancy for patients.

For each group, the cost of using the CT scanner was lower than the cost of an observation unit stay and stress testing, and furthermore the QALYs, or life expectancies, were higher. This is largely due to the superior diagnostic test performance of the CT scanner, and the avoidance of the observation unit costs.

"There is relatively little data available with respect to the cost-effectiveness of this new technology, the 64-slice CT scanner, in low-risk chest pain patients in an emergency department setting. I'm hoping the results of this study help build the case for conducting a large randomized controlled trial in order to further the body of research," notes Dr. Khare.

"There is good evidence that the use of this technology will be the standard of care in the future, and we must determine if the benefit will outweigh the cost. This study shows that it does, and more importantly, that it may even be cost-saving in certain situations," comments Dr. Khare. He adds, "Ultimately, this new technology may be the best care for the patient by quickly telling the patient and the physician if the chest pain is due to a blocked coronary artery."

Source: Northwestern Memorial Hospital

Related stories:

Low neighborhood income, Medicaid linked to delays in reaching hospital after heart attack
Individuals with Medicaid insurance and those who live in neighborhoods with lower household incomes appear less likely than others to reach the hospital within two hours of having a heart attack, according to a report in the September 22 issue of Archives of Internal Medicine.
Air pollution damages more than lungs: Heart and blood vessels suffer too
As athletes from around the world compete in the Beijing Olympics, many are on alert for respiratory problems caused by air pollution. They should also be concerned about its toxic effects on the heart and cardiovascular system, mounting research shows.
Coronary CTA costs less than standard of care for triaging women with acute chest pain
Non-invasive coronary CT angiography (CTA) is more cost-effective than current tests for diagnosing women with low risk of a heart attack who come to the emergency room with acute chest pain, according to a recent study conducted by researchers at Harvard University in Cambridge, MA.
New implant device remotely monitors heart failure patients at Northwestern Memorial
Chest pain and shortness of breath are common symptoms that send tens of thousands of heart failure (HF) patients into U.S. hospitals each month. Cardiologists at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital may be able to curb such visits for some of their HF patients as they recently became Chicago's first researchers using a new wireless pressure sensor technology that allows them to track the pulmonary artery pressure of the subjects while these subjects remain at home.
Study shows emergency physicians have good first instincts in diagnosing heart attacks
A study out of Wake Forest University Baptist Medical Center demonstrates emergency room doctors are correctly identifying patients who are having a heart attack, even when laboratory tests haven't yet confirmed it.
Chest pain center accreditation linked with better outcomes in heart attack patients
Hospitals accredited by the Society of Chest Pain Centers (SCPC) have been shown to perform better in the heart attack core measures established by Centers for Medicare and Medicaid Services (CMS) as compared to non-accredited hospitals, according to a national study led by an Emory University researcher.
New kidney protein speeds/improves the diagnosis of failing kidneys
Walk into any emergency department complaining of chest pain and you are likely to have blood drawn. Within hours it should be clear whether you've had a heart attack, based on enzyme levels in your blood and whether those levels reveal the tissue damage normally associated with a heart attack or other major cardiac event.
Some women more likely to miss or ignore heart attack warning signs
Many women under age 55 aren’t seeking timely treatment for heart attack because they expect the warning signs and their reaction to follow a Hollywood script — tightening in the chest, shortness of breath, clutching the chest while dropping to one knee.

News discussion:

Medicine & Health news