Economic evaluation of applying the Canadian Syncope Risk Score in an Australian emergency department

Abstract

Objective To evaluate the Canadian Syncope Risk Score (CSRS) in syncope patients presenting to the ED from an economic perspective, using very‐low and low‐risk patients (CSRS −3 to 0) as a threshold for avoiding hospital admissions. Methods A decision‐analytic model, specifically a decision‐tree, was developed to evaluate application of the CSRS. A hypothetical cohort of 1000 patients was modelled based on characteristics and outcome of patients enrolled in a clinical validation study performed alongside this evaluation. Several analytic based approaches were used to handle model outputs and uncertainties. Results For a cohort of 1000 patients, applying the CSRS was associated with 169 less inpatient admissions from the ED, when compared to usual care. There was also a cost‐saving of $8255 per admitted patient, when the CSRS was applied, compared to usual care. Adopting the CSRS was the optimal approach in all scenario analyses and was robust to changes in model parameters. More than three‐quarters (78.6%) of all model simulations showed that applying the CSRS is a cost‐saving approach to managing syncope. There was high confidence in all results, with the approach using the CSRS reducing the costs and number of syncope‐related hospital admissions. Conclusions Compared to usual care, applying the CSRS appeared as a cost‐effective strategy. This new evidence will help decision‐makers choose cost‐effective approaches for the management of patients presenting to the ED with syncope, as they search for efficient ways to maximise health gain from a finite budget.

Incidence and Outcomes of Adult Syncope Presentations to Emergency Medical Services

“…These studies have then been integral in the development of risk stratification tools to help guide clinical decision making within the ED (Cosgriff, Kelly, & Kerr, 2007;Venkatesh Thiruganasambandamoorthy et al, 2020;Andrea Ungar et al, 2010). These risk stratification tools are cost-effective and are now being shown to effectively reduce patient hospitalisation (Anand et al, 2018;Brain et al, 2023;Zimmermann et al, 2022).…”