ArticleEmergency medicine journal : EMJ2005
Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial.
Article in Emergency medicine journal : EMJ, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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, 2 syntheses or guidelines pooled it.
- Quality of health economic evaluations in emergency medicine journals: a systematic review.CJEM · 2023Pooled it
- Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014.Clinical research in cardiology : official journal of the German Cardiac Society · 2015Guideline
- Review
- Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the "German chest pain unit registry".Clinical research in cardiology : official journal of the German Cardiac Society · 2012Article
- Self-referral to chest pain units: results of the German CPU-registry.European heart journal. Acute cardiovascular care · 2012Article
- GRACE risk score as predictor of in-hospital mortality in patients with chest pain.Clinical research in cardiology : official journal of the German Cardiac Society · 2010Article
- Article
- Improved outcome in acute coronary syndrome by establishing a chest pain unit.Clinical research in cardiology : official journal of the German Cardiac Society · 2010Article
- Acute nontraumatic chest pain in emergency department and cost-effectiveness evaluation.The Eurasian journal of medicine · 2008Article
- The PRIMA study: presentation ischaemia-modified albumin in the emergency department.Emergency medicine journal : EMJ · 2006Article
- Enzymology of NAD+ homeostasis in man.Cellular and molecular life sciences : CMLS · 2004Review
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.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe ESCAPE trial showed that chest pain observation unit (CPOU) care appeared to be cost effective compared with routine care. This finding may not be generalizable to hospitals that currently admit fewer patients than the trial hospital or that require higher direct costs to provide CPOU care. This study aimed to explore these issues in sensitivity analyses and develop a nomogram to allow prediction of whether a CPOU will be cost effective in a specific hospital.
methodsData from the ESCAPE trial was used to populate a decision analysis model comparing CPOU with routine care. Sensitivity analyses examined the effect of varying the admission rate with routine care and the direct running costs of CPOU care following which the nomogram was created.
resultsCPOU care provided improved outcome (0.3936 v 0.3799 QALYs) at lower cost (pound sterling 478 v pound sterling 556 per patient), with fewer patients admitted (37% v 54%). Mean cost of CPOU and routine care was pound sterling 116 and pound sterling 73, respectively, and of inpatient hospital stay was pound sterling 312. The mean post-discharge cost for CPOU and routine care was pound sterling 253 and pound sterling 309, respectively. Sensitivity analyses showed that CPOU care will not reduce costs at a hospital that currently admits fewer than 35% of patients, or a hospital that expects to incur direct CPOU running costs of pound sterling 60 per patient more than the trial hospital.
conclusionsFindings of the ESCAPE trial are likely to be generalizable to most settings. The nomogram presented here can be used to predict cost effectiveness in a specific hospital.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.