The Impact of CT Coronary Angiography on the Business of Acute Chest Pain: Resource Utilization, Cost and Length of Stay

Introduction: Chest pain is one of the most frequent presentations to the emergency department, resulting in a large number of hospital admissions and diagnostic tests. CT coronary angiography (CTCA) has been shown to provide accurate information, without necessarily resorting to invasive, costly tests, such as coronary angiography. Managers and funders are often concerned that CTCA availability may lead to over-investigation and impact unfavorably on hospital budgets. Here, we report on the impact of CTCA on hospital services, with an emphasis on resource utilization, using individual patient data. Methods: We compare a cohort of patients presenting with chest pain to the emergency department before and after implementation of the CTCA program at Waitemata District Health Board (WDHB), in August 2011. Information on LOS, investigations performed, demographic/comorbidity details and cost related to the admission were obtained from clinical coding information, existing databases and the accounts department (using a schedule that breaks cost into resource pools). Follow up was 1 year. WDHB provides hospital services for ~600,000 people. Initial Results: 25,199 patients were admitted with the presenting complaint of chest pain between February 2008 and August 2011, aged 18yrs-106 yrs. The mean LOS was 3.056 days. A total of 2,087 angiograms (8.3%) were performed in this cohort. Between August 2011 and February 2014, 20,642 patients presented with chest pain, aged 18yrs-102yrs. The mean LOS was 2.727 days (p<0.001). A total of 1,442 angiograms (7.0%, p<0.05) were performed in this cohort. A total of 1,246 inpatient CTCA scans were done during this period. There was no significant difference in readmission rate or other non-invasive testing. There was a trend toward lower costs associated with chest pain admissions, without adjusting for inflation. Conclusion: The CTCA program appears to have been beneficial in decreasing LOS and the total number of angiograms performed. CTCA availability has not led to uncontrolled service growth. Savings made from decreased resource utilization may justify the capital/staff expenditure required to implement the program. Further research to understand the economics of CTCA would be beneficial.