Cost-Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain

Abstract

Patients at low risk for acute coronary syndrome (ACS) who present to the emergency department complaining of acute chest pain place a substantial economic burden on the U.S. health care system. Noninvasive 64-MDCT coronary angiography may facilitate their triage, and we evaluated its cost-effectiveness. A microsimulation model was developed to compare costs and health effects of performing CT coronary angiography and either discharging, stress testing, or referring emergency department patients for invasive coronary angiography, depending on their severity of atherosclerosis, compared with a standard-of-care (SOC) algorithm that based management on biomarkers and stress tests alone. Using CT coronary angiography to triage 55-year-old men with acute chest pain increased emergency department and hospital costs by $110 and raised total health care costs by $200. In 55-year-old women, the technology was cost-saving; emergency department and hospital costs decreased by $410, and total health care costs decreased by $380. Compared with the SOC, CT coronary angiography-based triage extended life expectancy by 10 days in men and by 6 days in women. This translated into corresponding improvements of 0.03 quality-adjusted life years (QALYs) and 0.01 QALYs, respectively. The incremental cost-effectiveness ratio for CT coronary angiography was $6,400 per QALY in men; in women, CT coronary angiography was cost-saving. Cost-effectiveness ratios were sensitive to several parameters but generally remained in the range of what is typically considered cost-effective. CT coronary angiography-based triage for patients with low-risk chest pain is modestly more effective than the SOC. It is also cost-saving in women and associated with low cost-effectiveness ratios in men.