The researchers developed a microsimulation coronary CTA model which reviewed costs and health effects of performing coronary CT 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. “The SOC is to get a few sets of cardiac enzymes on these patients and to perform a stress test. If either is positive, the patient may be considered for cardiac catheterisation,” said Joseph Ladapo, lead author of the study.
Coronary CT angiography was 410 US-Dollars less (in emergency department and hospital costs) than the SOC to triage a 55-year-old woman, said Ladapo. Total health care costs decreased by 380 US-Dollars, he said. “At nearly every age level, women are less likely to have coronary artery disease than men; they are more likely to be found to have normal coronaries on cardiac CT, and therefore more likely to be discharged. Since they are discharged, costs go down,” Ladapo said.
55-year-old men with acute chest pain increased emergency department and hospital costs by 110 US-Dollars and raised total health care costs by 200 US-Dollars, Ladapo said. Coronary CT angiography raised overall costs in men primarily because it was more likely to identify patients with coronary artery disease, Ladapo added. The patients needed additional testing or treatment, so costs went up.
“As physicians design protocols that further reduce the radiation dose associated with exams, and as engineers design faster multislice CTs, the radiation dose (the main major risk of the procedure) will fall,” said Ladapo. “Indeed, it has already fallen significantly for these reasons.”
MEDICA.de; Source: American Roentgen Ray Society (ARRS)