ArticleEmergency medicine journal : EMJ2003
Cost effectiveness of diagnostic strategies for patients with acute, undifferentiated chest pain.
Article in Emergency medicine journal : EMJ, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Quality of health economic evaluations in emergency medicine journals: a systematic review.CJEM · 2023Pooled it
- A randomised controlled trial to measure the effect of chest pain unit care upon anxiety, depression, and health-related quality of life [ISRCTN85078221].Health and quality of life outcomes · 2004Trial
- Coronary Computed Tomography Angiography to Exclude Acute Coronary Syndrome in Low-Risk Chest Pain Patients.Journal of cardiovascular development and disease · 2025Review
- Specific Pharmacological Profile of AJournal of the American Heart Association · 2018Article
- Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment.International journal of cardiology. Heart & vasculature · 2015Review
- Societal costs of non-cardiac chest pain compared with ischemic heart disease--a longitudinal study.BMC health services research · 2013Article
- The potential role for the use of cardiac computed tomography angiography for the acute chest pain patient in the emergency department.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2011Article
- Low-risk patients with chest pain in the emergency department: negative 64-MDCT coronary angiography may reduce length of stay and hospital charges.AJR. American journal of roentgenology · 2009Article
- Cost effectiveness of chest pain unit care in the NHS.BMC health services research · 2008Article
- Direct hospital costs of chest pain patients attending the emergency department: a retrospective study.BMC emergency medicine · 2006Article
- Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial.Emergency medicine journal : EMJ · 2005Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesPatients presenting to hospital with acute, undifferentiated chest pain have a low, but important, risk of significant myocardial ischaemia. Potential diagnostic strategies for patients with acute, undifferentiated chest pain vary from low cost, poor effectiveness (discharging all home) to high cost, high effectiveness (admission and intensive investigation). This paper aimed to estimate the relative cost effectiveness of these strategies.
methodsDecision analysis modelling was used to measure the incremental cost per quality adjusted year of life (QALY) gained for five potential strategies to diagnose acute undifferentiated chest pain, compared with the next most effective strategy, or a baseline strategy of discharging all patients home without further testing.
resultsCardiac enzyme testing alone costs pound 17 432/QALY compared with discharge without testing. Adding two to six hours of observation and repeat enzyme testing costs an additional pound 18 567/QALY. Adding exercise testing to this strategy costs pound 28 553/QALY. A strategy of overnight admission, enzyme, and exercise testing has an incremental cost of pound 120 369/QALY, while a strategy consisting of overnight admission without exercise testing is subject to extended dominance. Sensitivity analysis revealed that the results are sensitive to variations in the direct costs of running each strategy and to variation in assumptions regarding the effect of diagnostic testing upon quality of life of those with non-cardiac disease.
conclusionObservation based strategies incur similar costs per QALY to presently funded interventions for coronary heart disease, while strategies requiring hospital admission may be prohibitively poor value for money. Validation of the true costs and effects of observation based strategies is essential before widespread implementation.
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Registered trials
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