Healthcare cost burden of acute chest pain presentations

Abstract

BackgroundThis study aimed to estimate the direct healthcare cost burden of acute chest pain attendances presenting to ambulance in Victoria, Australia, and to identify key cost drivers especially among low-risk patients.MethodsState-wide population-based cohort study of consecutive adult patients attended by ambulance for acute chest pain with individual linkage to emergency and hospital admission data in Victoria, Australia (1 January 2015–30 June 2019). Direct healthcare costs, adjusted for inflation to 2020–2021 ($A), were estimated for each component of care using a casemix funding method.ResultsFrom 241 627 ambulance attendances for chest pain during the study period, mean chest pain episode cost was $6284, and total annual costs were estimated at $337.4 million ($68 per capita per annum). Total annual costs increased across the period ($310.5 million in 2015 vs $384.5 million in 2019), while mean episode costs remained stable. Cardiovascular conditions (25% of presentations) were the most expensive (mean $11 523, total annual $148.7 million), while a non-specific pain diagnosis (49% of presentations) was the least expensive (mean $3836, total annual $93.4 million). Patients classified as being at low risk of myocardial infarction, mortality or hospital admission (Early Chest pain Admission, Myocardial infarction, and Mortality (ECAMM) score) represented 31%–57% of the cohort, with total annual costs estimated at $60.6 million–$135.4 million, depending on the score cut-off used.ConclusionsTotal annual costs for acute chest pain presentations are increasing, and a significant proportion of the cost burden relates to low-risk patients and non-specific pain. These data highlight the need to improve the cost-efficiency of chest pain care pathways.

Diagnostic rate estimation from Medicare records: Dependence on claim numbers and latent clinical features

“…These ‘steep slope’ conditions included ominous and high acuity diagnoses, e.g., chest pain. [ 42 , 43 ] The differences observed here between these groups have import for current and future research.…”

“…Most of these conditions are associated with high acuity care. [ 42 , 43 ] The conditions with negative or near-zero slope, i.e., −0.16 to 0.1, all reach a maximum diagnostic rate at a claim number below the maximum, i.e., the curve plateaus. The five conditions with most negative slope are plotted in Fig.…”

Healthcare and economic cost burden of emergency medical services treated non-traumatic shock using a population-based cohort in Victoria, Australia

“…ED costs were determined from the Victorian-specific National Hospital Cost Data Collection for 2018–2019, which provides the average cost of ED episodes of care for various scenarios that include whether the patient was admitted to hospital, was transferred to another hospital, discharged against medical advice or died within the ED (online supplemental table 1). 17 This methodology has been previously used and has been described previously 18…”

Chest pain as an interdisciplinary problem – emphasis on somatoform disorders

“…В последнее время стали накапливаться убедительные свидетельства того факта, что среди пациентов с болями в груди можно выделить подгруппу, которую можно квалифицировать в рамках расстройств телесного дистресса. В частности, S. Flovenz показал, что пациенты с болями в груди, отвечающие клиническим критериям расстройства персистирующих телесных симптомов 1 , достоверно отличаются от остальных пациентов с болями в груди [36]. Для пациентов с соматизированной болью в грудной клетке были характерны следующие социодемографические и клинические особенности: большее число неработающих лиц без оформления инвалидности, более высокий уровень тревоги (как в целом, так и тревоги за здоровье) и депрессии, а также повышенная склонность к руминативному мышлению.…”

“…Боль в области грудной клетки является одной из самых частых жалоб, по поводу которых пациенты обращаются к врачу или вызывают бригаду скорой медицинской помощи. По статистическим данным, касающимся нагрузки на медицинскую сеть, среди всех болевых синдромов боль в груди стоит на втором месте по обращаемости пациентов, уступая только болям в области живота [1]. В свою очередь, популяционные исследования свидетельствуют в пользу того, что на протяжении жизни боль в груди беспокоит до одной трети населения развитых стран, а одномоментная представленность болей в груди составляет 5% [2].…”