Stress echocardiography in the district hospital setting: a cost-saving analysis

Wennike, N., Shah, B.N., Boger, E., Senior, R. and Greaves, K. (2010) Stress echocardiography in the district hospital setting: a cost-saving analysis. European Journal of Echocardiography, 11 (5), 401-405. (doi:10.1093/ejechocard/jep223). (PMID:20067915)

Abstract

Aims: Accurate and cost-effective techniques are required for investigating patients experiencing chest pain, given the significant workload this patient cohort represents. We determined the cost impact of stress echocardiography compared with myocardial perfusion scintigraphy and coronary angiography in the investigation of patients with chest pain deemed unsuitable for exercise treadmill testing.

Methods and results: A total of 200 patients with chest pain—with a low–intermediate probability of coronary artery disease—consecutively referred for stress echocardiography were recruited. Referring clinicians were asked which management strategy they would have chosen were the stress echocardiography service unavailable. The cost saving of stress echocardiography, an accuracy analysis, and adverse outcomes at 6 and 24 months follow-up were determined. The total cost attributable to the stress echocardiography service was £58 368. If unavailable, 78 (39%) patients would have been referred for angiography and 122 (61%) for perfusion scintigraphy at a cost of £56 316 and £42 090, respectively, with a total cost of £98 406. This represents a cost saving of £40 038.

Conclusion: Stress echocardiography is a cost saving method for the investigation of chest pain in patients with low–intermediate risk of flow limiting coronary artery disease in the district hospital setting.

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