THE BURDEN OF NON-CARDIAC CHEST PAIN IN AUSTRALIA
M.A. Fitzpatrick*, M. Dodd, d. Schoevers, E. Tracey.
Cardiology Department, Nepean Hospital and Health Outcomes Unit, Wentworth Area Health Service.
Introduction: Little is known about the outcomes or costs of caring for patients with non-cardiac chest pain (NCP) in Australia, yet it accounts for 2-5% of all emergency dept (ED) visits.
Aim: To determine the crude costs of health care utilisation (HCU) of NCP.
Methods: Prospective cohort study of all patients presenting to our ED with chest pain (CP) in a 16 week (12/1-5/5/97) and 6 week (1/11-15/12/97) period. Outcome data were obtained by review of hospital records and telephone follow-up interview 4 months post-discharge (FU). NCP was defined as the absence of ischaemic heart disease (IHD) prior to and during FU. Crude costs of services were determined from DRG data ($1,893 for DRG 261) for our hospital and Medicare schedule fees. For the calculation, it was assumed that all pts had this admission DRG. ED costs were estimated from ED fraction of DRG 261 (35% = $662). The costs of drug therapy were not assessed.
Results: In the 22 weeks, 678 pts presented with CP. 508 (75%) had FU data enabling assessment of CP status and HCU costs: 194 had IHD and 314 had NCP. Estimated crude costs of HCU for NCP pts were:
|
Number |
Cost |
|
|
Initial ED assessments (no admission) |
$152,260 |
|
|
Initial admissions |
84 |
$159,012 |
|
FU doctor visits |
$ 18,840 |
|
|
Total FU ED presentations |
76 |
$ 50,312 |
|
Total FU readmissions |
67 |
$126,831 |
|
Tests: EST, nuclear, gastro, radiology |
$ 43,450 |
|
|
TOTAL |
$550,705 |
|
The estimated annual cost of HCU by NCP pts presenting to our ED was $Amill1.4, while the estimated range for Australia was $Amill90-130. Despite these efforts, 9% of NCP pts continued to experience pain >1x/wk and 7% reported >= moderate limitation to daily living. Initial inpatient care after ED evaluation accounted for 18% of HCU costs, but did not alter outcomes. Representation to ED including admission during FU accounted for 30% of total HCU costs.
Conclusions: Outcome for many NCP pts appears to be suboptimal, while their HCU costs are considerable. Strategies to prevent ED representation could improve pt outcomes and decrease costs.
