ArticleBMJ open2022
Is a novel diagnostic pathway for cardiology outpatient clinics in Singapore lower cost than existing practice: a cost modelling study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors at 2 institutions in 1 country.
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Abstract
objectiveTo evaluate the potential for change to costs from a decision to adopt a novel diagnostic pathway for referrals to cardiology outpatients with symptoms of chest pain.
designCosts modelling study using existing observational data, with a cost year of 2018.
settingSpecialist Heart Centre in Singapore.
participantsAll new referrals (n=10 622) to the outpatient clinics for investigation between January 2017 and December 2017.
interventionsTwo competing testing regimes are compared in a decision tree model. Current practice includes classification of patients by their risk and the use of treadmill tests, calcium scores, functional testing and CT angiogram. New practice offers a fundamental difference in use of diagnostics for patients, with some offered angiogram directly and for low-risk patients a calcium score is used to refine risk stratification. OUTCOME MEASURES: The expected cost difference between testing alternatives.
resultsThe expected cost saving from 'New Practice' as compared with 'Current Practice' is $S764 per patient. There is a 50% probability the savings per patient range between $S764 and $S824 and a 90% probability they are between $S616 and $S912. The expected savings to Singapore national health services are $S26.8 million annually, with a range of $S16.2 to $S41.1 million.
conclusionsWe find some evidence that using a coronary calcium score, which can be performed with a fraction of the time and cost of a CT coronary angiogram, saves costs to health services.
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