AEM: CT in the ED is cost-effective for low-risk patients with angina

Using a 64-slice CT scanner is more cost-effective than an overnight stay in the observation unit and cardiac stress testing for patients with chest pain in an emergency department (ED), according to a study published in the July issue of Academic Emergency Medicine.

The study, led by Rahul Khare, MD, emergency department physician and assistant director of operations at Northwestern Memorial Hospital in Chicago, sought to determine the cost-effectiveness of utilizing a CT scanner to evaluate low-risk chest pain patients in theemergency room.

“Currently it is a challenge to identify chest pain patients with significant coronary artery disease (CAD) in a timely and cost-effective manner,” Khare said.

Khare utilized a computer model with one standard patient, a 54-year old male, 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 CAD 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 were higher. This is largely due to the superior diagnostic test performance of the CT scanner, and the avoidance of the observation unit costs, according to Khare.

"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," he noted.

“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," Khare concluded. "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.”