Cost Impact of a Coronary Computed Tomography Angiography-Based Diagnostic Pathway for Low-Risk Chest Pain in the Emergency Department.

BACKGROUND

Emergency chest pain presentations represent a substantial burden on healthcare resources. The use of coronary computed tomography angiography (CCTA) has been shown to be safe and associated with reduced costs in stable outpatients referred for invasive coronary angiography (ICA). The history, electrocardiogram, age, risk factors, troponin (HEART) risk assessment score is used to risk-stratify patients with undifferentiated chest pain. We sought to evaluate the cost impact of an accelerated outpatient CCTA-based diagnostic pathway compared with inpatient ICA for the investigation of patients presenting acutely to the emergency department (ED) with symptoms suggestive of coronary artery disease (CAD) at a tertiary referral centre.

METHODS

We performed a comparative cost analysis based on retrospective observational data including stable adult ED patients who presented in 2023.

RESULTS

369 patients underwent outpatient CCTA and 376 were admitted for ICA. The median time to outpatient CCTA was 14 days (interquartile range (IQR) 5-24). Use of the CCTA-based pathway was associated with a 78% reduction in diagnostic pathway costs (€2990 per patient), when compared to admission for ICA, for the investigation of lower-risk individuals, with no increase in 30-day mortality or myocardial infarction. Patients referred for outpatient CCTA had a significantly shorter median length-of-stay compared with those admitted for ICA (6.5 hours (IQR 5.0-9.0) vs. 5 days (IQR 3.0-14.9); p < 0.05).

CONCLUSIONS

Use of an accelerated outpatient CCTA-based diagnostic pathway for low-risk chest pain patients in the ED was associated with substantial cost savings and reduced hospital utilization without evidence of compromised short-term safety.