Table 2.
Assessment of low-risk patients with chest pain in the two settings
|
0/1-h algorithm at emergency primary care OUT-ACS cohort, Oslo (n = 1485) |
All hs-cTn measurements at hospital ED Low-risk cohort, Drammen (n = 567) |
Differences | |||
|---|---|---|---|---|---|
| Conservative scenario | Base case scenario | Conservative scenario | Base case scenario | ||
|
EMS to emergency primary care (Costs per transport) |
€ 162 (€ 559; 29%) |
€ 162 (€ 559; 29%) |
€ 162 (€ 559; 29%) |
€ 162 (€ 559; 29%) |
€ 0 (assumed similar) |
|
Primary care emergency clinic General costs/ consultationa |
€ 166 | € 166 | € 166 | € 166 |
€ 0 (assumed similar) |
| Additional costs with a 0/1-h algorithm |
€ 230 • Diagnostics € 41 • Personnel, tariffs € 137 • Cardiac outpatient testing € 52 |
€ 192 • Diagnostics € 41 • Personnel, wages € 99 • Cardiac outpatient testing € 52 |
(none) | (none) | € 230 or 192 |
| EMS to hospital (costs per transport) | (none) | (none) | € 419 (€ 559; 75%) | € 503 (€ 559; 90%) | € -419 or -503 |
| Hospital (DRG tariffsa) | (none) | (none) | € 1483 | € 1483 | € -1483 |
| TOTAL | € 558 | € 520 | € 2230 | € 2314 | € -1672 or -1794 |
| LOS | Mean: 4.0 h | Mean: 3.4 h | Mean: 22.3 h | Mean: 22.3 h | -18.3 h or -18.9 h |
| QALY |
-0.00760 LOS: -0.00011 AMI: -0.00749 |
-0.00009 LOS: -0.00009 AMI: -0.0 |
-0.00574 LOS: -0.00059 AMI: -0.00515 |
-0.00059 LOS: -0.00059 AMI: -0.0 |
-0.00186 or + 0.00050 |
Details regarding cost estimates, probabilities and calculations are listed in Online Tables S1, S2, and S4. All numbers are adjusted to 2020 figures
AMI Acute myocardial infarction, DRG Diagnosis-related groups, EMS Emergency medical services, ED Emergency department, EUR Euro, LOS Length of stay, OUT-ACS One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome, QALY Quality-adjusted life year
aGeneral costs by standard consultation per patient encompass service costs, building, personnel, administration etc, assumed similar at the primary care emergency clinics in Oslo and Drammen