Systematic Review of Economic Evaluations of Units Dedicated to Acute Coronary Syndromes

André Luis Ferreira Azeredo-Da-Silva; Silvana Perini; Pedro Henrique Rigotti Soares; Carisi Anne Polaczyk

doi:10.1016/j.jval.2015.11.015

Systematic Review of Economic Evaluations of Units Dedicated to Acute Coronary Syndromes

Value Health. 2016 Mar-Apr;19(2):286-95. doi: 10.1016/j.jval.2015.11.015. Epub 2016 Feb 3.

Authors

André Luis Ferreira Azeredo-Da-Silva¹, Silvana Perini², Pedro Henrique Rigotti Soares², Carisi Anne Polaczyk³

Affiliations

¹ Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Porto Alegre Clinical Hospital, Porto Alegre, Brazil; National Institute for Health Technology Assessment (INCT/IATS-Brazil), Porto Alegre, Brazil. Electronic address: andre@htanalyze.com.
² Porto Alegre Clinical Hospital, Porto Alegre, Brazil.
³ Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; National Institute for Health Technology Assessment (INCT/IATS-Brazil), Porto Alegre, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Cardiovascular Division of Porto Alegre Hospital, Porto Alegre, Brazil.

PMID: 27021764
DOI: 10.1016/j.jval.2015.11.015

Abstract

Background: Dedicated units for the care of acute coronary syndrome (ACS) have been submitted to economic evaluations; however, the results have not been systematically presented.

Objective: To identify and summarize economic outcomes of studies on hospital units dedicated to the initial care of patients with suspected or confirmed ACS.

Methods: A systematic review of literature to identify economic evaluations of chest pain unit (CPU), coronary care unit (CCU), or equivalent units was done. Two search strategies were used: the first one to identify economic evaluations irrespective of study design, and the second one to identify randomized clinical trials that reported economic outcomes. The following databases were searched: MEDLINE, EMBASE, CENTRAL, and National Health Service (NHS)Economic Evaluation Database. Data extraction was performed by two independent reviewers. Costs were inflated to 2012 values.

Results: Search strategies retrieved five partial economic evaluations based on observational studies, six randomized clinical trials that reported economic outcomes, and five model-based economic evaluations. Overall, cost estimates based on observational studies and randomized clinical trials reported statistically significant cost savings of more than 50% with the adoption of CPU care instead of routine hospitalization or CCU care for suspected low-to-intermediate risk patients with ACS (median per-patient cost US $1,969.89; range US $1,002.12-13,799.15). Model-based economic evaluations reported incremental cost-effectiveness ratios below US $ 50,000/quality-adjusted life-year for all comparisons between intermediate care unit, CPU, or CCU with routine hospital admissions. This finding was sensible to myocardial infarction probability.

Conclusions: Published economic evaluations indicate that more intensive care is likely to be cost-effective in comparison to routine hospital admission for patients with suspected ACS.

Keywords: CCU; CPU; chest pain unit; coronary care unit; cost effectiveness; systematic review.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Acute Coronary Syndrome / diagnosis
Acute Coronary Syndrome / economics*
Acute Coronary Syndrome / mortality
Acute Coronary Syndrome / therapy*
Coronary Care Units / economics*
Coronary Care Units / standards
Cost Savings
Cost-Benefit Analysis
Decision Support Techniques
Hospital Costs*
Humans
Models, Economic
Patient Admission / economics
Quality Indicators, Health Care
Quality-Adjusted Life Years
Treatment Outcome