Cost effectiveness and rule-out strategy of MDCT-CA in patients with undifferentiated chest pain in emergency department

Purpose: To determine whether a negative coronary CT angiography could accurately rule out patients with undifferentiated chest pain, low TIMI risk score, for a safe release from the ED. The second endpoint is to determine the prognostic value at 2 years in case of negative MDCT-CA. Methods and Materials: Between January 2009 and August 2012, 176 consecutive patients undergoing CA-MDCT in an Emergency Department were considered. Patients with undifferentiated chest pain were addressed into an accelerated diagnostic protocol (ADP): clinical examination, MDCTCA; the positive cases were recovered and underwent CA. If MDCT-CA was negative for significant CAD the patient was dismissed from the ED and taken under follow-up for 2 years. The costs of every protocol and the amount of costs for individual methods were calculated. Based on the results, the two diagnostic paths were compared about cost/effectiveness ratio. Results: At TIMI score only 30 % of the patients resulted with high risk, whereas MDCT-CA was judged positive in 40 % of the cases. MDCTCA compared to CA revealed an accuracy of 97.8%, PPV and NPV were 99 % and 100 %. The ADP revealed lower costs than the protocol with only hospitalization (11645€ against 5322€), and showed better cost/effectiveness ratio. At 2-year follow-up 99.3% of the patients resulted well being. Conclusion: The ADP can help better than TIMI score to rule out patients with undifferentiated chest pain. Moreover, cost analysis demonstrated a better cost effectiveness ratio in comparison to the hospitalization, also confirmed with a long-term follow-up.