ArticleAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2025
Cost-effectiveness of early noninvasive cardiac testing for suspected acute coronary syndrome.
Article in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- The effect of follow-up reexamination on the long-term prognosis of patients with acute coronary syndrome undergoing coronary angiography.BMC medicine · 2025Article
- Efficacy and safety of Shugan Jieyu Capsule in the treatment of depressive state after acute coronary syndrome: study protocol for a multicenter randomized controlled trial.Frontiers in psychiatry · 2025Article
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Authors and funding
9 authors.
Funding
Abstract
backgroundEarly noninvasive cardiac testing (NIT) is often performed in the initial workup of patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS). Our study objective was to calculate the cost-effectiveness of adopting early NIT for risk stratification to avoid future nonfatal acute myocardial infarction (MI) or death.
methodsTo obtain the incremental difference in cost and clinical outcomes, we first conducted a multicenter retrospective cohort study within the member population of the Kaiser Permanente Southern California integrated health care delivery system. We then adapted existing cost effectiveness models to generate long-term costs and quality-adjusted life-years (QALYs) gained by NIT.
resultsThe cohort included 89,387 patients (mean age 57 years, 58% female) and 19% received early NIT. Total cost was higher by $2357 (95% confidence interval [CI] $77 to $4821) for early NIT compared to no early NIT and was mainly due to the increased cost of the index ED visit. Early NIT was associated with lower composite risk of death/nonfatal MI (absolute risk difference -3.7%, 95% CI -4.4% to -3.01%) during a 1-year follow-up. From a payor's perspective, early NIT was cost-effective at $5268/QALYs.
conclusionsIn patients with suspected ACS evaluated in the ED, incorporation of early NIT was associated with an overall increase in cost of health care that was driven by increased cost of the initial ED visit. However, due to the significant clinical benefits, early NIT was cost-effective in the low- and intermediate-risk patients while it is a dominant strategy in high-risk patients saving cost and QALYs.
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