Abstract 12738: Comparing Costs of Non-Invasive Cardiac Diagnostic Tests and Deferred Testing for Incident Chest Pain - A Population-Based Study

Abstract

Introduction: Cardiac non-invasive diagnostic tests (NIT) for patients with suspected coronary artery disease cost > $3 billion annually in the US, and may be overused. Consequently, comparing costs of different NIT strategies, including deferred testing, is of urgent importance to healthcare planning. Methods: We compared population-based downstream costs between patients undergoing evaluation for chest pain in Ontario, CA with one of four NIT tests (exercise stress testing (GXT), stress echocardiography, cardiac computed tomography angiography (CCTA) and myocardial perfusion imaging (MPI)) as well as no-testing. To compare costs among the tested and non-tested groups, we used a log-gamma generalized linear model to account for the skewed distribution of health care costs, adjusting for relevant clinical covariates. Results: Of 2,340,699 included patients, 481,170 (21%) received one of four NITs: GXT: 254,492 (53%), MPI: 154,137 (32%), stress echo: 69,160 (14%), and CCTA: 3,381 (<1%). After adjustment for patient characteristics including cardiac risk factors, frailty and location (Table 1), receipt of any NIT was associated with a 12% reduction in downstream 1-year mean costs compared to those without an NIT (cost ratio 0.88, 95%CI 0.87, 0.89). Comparing the different testing strategies with no testing, both GXT (cost ratio 0.80, 95%CI 0.79-0.81) and stress echocardiography (cost ratio 0.82, 95%CI 0.81-0.83) had lower downstream costs, while both MPI (cost ratio 1.26, 95% CI 1.25, 1.27) and CCTA (cost ratio 1.29, 95% CI 1.23, 1.35) had higher downstream costs. Conclusions: In a large (>2 million) population-based cohort with incident chest pain, receipt of any type of non-invasive testing was associated with a 12% reduction in downstream costs compared to no testing. GXT and stress echocardiography had the least downstream costs, whereas CCTA and MPI had the highest costs. These findings may help inform testing decisions in chest pain patients.