Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography

pooled evidence from ROMICAT II and ACRIN-PA trials

Fabian Bamberg, Thomas Mayrhofer, Maros Ferencik, Daniel O. Bittner, Travis R. Hallett, Sumbal Janjua, Christopher L. Schlett, John T. Nagurney, James E. Udelson, Quynh A. Truong, Pamela K. Woodard, Judd E. Hollander, Harold Litt, Udo Hoffmann

    Research output: Contribution to journalArticle

    2 Citations (Scopus)

    Abstract

    Objectives: To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. Methods: We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Results: Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860–5935 in men, p < 0.001). Conclusions: CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. Key Points: • In this analysis, CAD and ACS increased with age and male gender.• CCTA in patients with acute chest pain results in varying resource utilisation.• Significant increase of diagnostic testing and cost with age for both sexes.• Cost to rule out ACS is higher in men and patients >60 years.• Improved selection of subjects for cardiac CTA result in more resource-driven implementation.

    Original languageEnglish (US)
    Pages (from-to)1-10
    Number of pages10
    JournalEuropean Radiology
    DOIs
    StateAccepted/In press - Sep 5 2017

    Fingerprint

    Acute Pain
    Chest Pain
    Acute Coronary Syndrome
    Costs and Cost Analysis
    Patient Selection
    Hospitalization
    Computed Tomography Angiography

    Keywords

    • Acute chest pain
    • Coronary CT angiography
    • Coronary stenosis
    • Cost analysis
    • Test utilisation

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging

    Cite this

    Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography : pooled evidence from ROMICAT II and ACRIN-PA trials. / Bamberg, Fabian; Mayrhofer, Thomas; Ferencik, Maros; Bittner, Daniel O.; Hallett, Travis R.; Janjua, Sumbal; Schlett, Christopher L.; Nagurney, John T.; Udelson, James E.; Truong, Quynh A.; Woodard, Pamela K.; Hollander, Judd E.; Litt, Harold; Hoffmann, Udo.

    In: European Radiology, 05.09.2017, p. 1-10.

    Research output: Contribution to journalArticle

    Bamberg, F, Mayrhofer, T, Ferencik, M, Bittner, DO, Hallett, TR, Janjua, S, Schlett, CL, Nagurney, JT, Udelson, JE, Truong, QA, Woodard, PK, Hollander, JE, Litt, H & Hoffmann, U 2017, 'Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography: pooled evidence from ROMICAT II and ACRIN-PA trials', European Radiology, pp. 1-10. https://doi.org/10.1007/s00330-017-4981-y
    Bamberg, Fabian ; Mayrhofer, Thomas ; Ferencik, Maros ; Bittner, Daniel O. ; Hallett, Travis R. ; Janjua, Sumbal ; Schlett, Christopher L. ; Nagurney, John T. ; Udelson, James E. ; Truong, Quynh A. ; Woodard, Pamela K. ; Hollander, Judd E. ; Litt, Harold ; Hoffmann, Udo. / Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography : pooled evidence from ROMICAT II and ACRIN-PA trials. In: European Radiology. 2017 ; pp. 1-10.
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    abstract = "Objectives: To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. Methods: We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Results: Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4{\%}). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1{\%} vs. 23.4{\%} and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860–5935 in men, p < 0.001). Conclusions: CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. Key Points: • In this analysis, CAD and ACS increased with age and male gender.• CCTA in patients with acute chest pain results in varying resource utilisation.• Significant increase of diagnostic testing and cost with age for both sexes.• Cost to rule out ACS is higher in men and patients >60 years.• Improved selection of subjects for cardiac CTA result in more resource-driven implementation.",
    keywords = "Acute chest pain, Coronary CT angiography, Coronary stenosis, Cost analysis, Test utilisation",
    author = "Fabian Bamberg and Thomas Mayrhofer and Maros Ferencik and Bittner, {Daniel O.} and Hallett, {Travis R.} and Sumbal Janjua and Schlett, {Christopher L.} and Nagurney, {John T.} and Udelson, {James E.} and Truong, {Quynh A.} and Woodard, {Pamela K.} and Hollander, {Judd E.} and Harold Litt and Udo Hoffmann",
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    T1 - Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography

    T2 - pooled evidence from ROMICAT II and ACRIN-PA trials

    AU - Bamberg, Fabian

    AU - Mayrhofer, Thomas

    AU - Ferencik, Maros

    AU - Bittner, Daniel O.

    AU - Hallett, Travis R.

    AU - Janjua, Sumbal

    AU - Schlett, Christopher L.

    AU - Nagurney, John T.

    AU - Udelson, James E.

    AU - Truong, Quynh A.

    AU - Woodard, Pamela K.

    AU - Hollander, Judd E.

    AU - Litt, Harold

    AU - Hoffmann, Udo

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    N2 - Objectives: To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. Methods: We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Results: Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860–5935 in men, p < 0.001). Conclusions: CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. Key Points: • In this analysis, CAD and ACS increased with age and male gender.• CCTA in patients with acute chest pain results in varying resource utilisation.• Significant increase of diagnostic testing and cost with age for both sexes.• Cost to rule out ACS is higher in men and patients >60 years.• Improved selection of subjects for cardiac CTA result in more resource-driven implementation.

    AB - Objectives: To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. Methods: We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Results: Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860–5935 in men, p < 0.001). Conclusions: CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. Key Points: • In this analysis, CAD and ACS increased with age and male gender.• CCTA in patients with acute chest pain results in varying resource utilisation.• Significant increase of diagnostic testing and cost with age for both sexes.• Cost to rule out ACS is higher in men and patients >60 years.• Improved selection of subjects for cardiac CTA result in more resource-driven implementation.

    KW - Acute chest pain

    KW - Coronary CT angiography

    KW - Coronary stenosis

    KW - Cost analysis

    KW - Test utilisation

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