Key result
Point-of-care chest pain triage must cut false-positive referrals by ~29% to become cost-saving.
Why the study?
The number of patients presenting with chest pain suspected of ACS in primary care and the potential cost effects of a future clinical decision rule incorporating a point-of-care test compared with current practice were not well established.
Does a future clinical decision rule incorporating a point-of-care test reduce healthcare costs compared to current practice in primary care patients with suspected ACS?
Does a future clinical decision rule incorporating a point-of-care test reduce healthcare costs compared to current practice in primary care patients with suspected ACS?
Answers are grounded in this paper and cite their sources.
A clinical decision rule incorporating a point-of-care test for primary care triage of suspected ACS could significantly reduce healthcare costs if it reduces false positive referrals by at least 29%.
The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on 'international data', at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.
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Willemsen et al. (2017) studied Acute chest pain suspected of acute coronary syndrome (n=1,054,729). Clinical decision rule (CDR) incorporating a point-of-care test (PoCT) vs. Current practice was evaluated on Minimum required relative reduction in ACS negative referrals (false positives) to become cost-saving (29.0% reduction). A clinical decision rule incorporating a point-of-care test requires at least a 29% relative reduction in false positive referrals to become cost-saving compared to current practice for triaging primary care patients with acute chest pain.
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