Cakir Zeynep, Saritas Ayhan, Aslan Sahin, Emet Mucahit, Kandis Hayati
Atatürk University, Faculty of Medicine, Department of Emergency Medicine, Erzurum, Turkey.
Eurasian J Med. 2008 Dec;40(3):119-23.
Cost-effective use of cardiac markers for the evaluation of ischemic chest pain (CP) patients at the emergency department (ED) is attracting the attention of researchers. The aim of this study is to define how cost-effective an approach should be for evaluate CP patients and to evaluate whether testing for cardiac markers is done cost-effectively in CP patients.
In this retrospective study, 1028 ischemic CP patients (aged from 17-89 years, 389 female, 639 male) with non-diagnostic electrocardiography (ECG) who were admitted to the ED between September 2002 and September 2003 were enrolled into the study.
The conditions of how diagnostic tests were actually ordered for these patients and how they should have been ordered cost-effectively were assessed and both the cost and effectiveness were compared. The actual total cost of the diagnostic tests ordered to investigate ischemic CP was $42,476. The cost would have been $32,342 if they had been ordered in the most cost-effective manner, for a total savings of $10,134. The ED cost, the calculated cost-effective cost and the lost amount were compared with the Student's t-test, and the differences between them was found to be statistically significant (p<0.001). The effectiveness was compared using the chi-square test and was found to be significant (χ(2)= 12.20, SD= 1, p<0.001).
In conclusion, fast and effective evaluation of ischemic CP in the ED and correct management of patients by correct determination of the risk factors provides a high level of cost-effectiveness. Every ED should determine an algorithm for patients admitted with CP and physicians should obey this algorithm.
在急诊科（ED）对缺血性胸痛（CP）患者进行具有成本效益的心脏标志物检测正吸引着研究人员的关注。本研究的目的是确定评估CP患者的方法应具有多高的成本效益，并评估在CP患者中进行心脏标志物检测是否具有成本效益。
在这项回顾性研究中，纳入了2002年9月至2003年9月期间因心电图（ECG）无诊断意义而入住急诊科的1028例缺血性CP患者（年龄17 - 89岁，女性389例，男性639例）。
评估了这些患者实际进行诊断性检查的方式以及应如何以成本效益方式进行检查，并对成本和效益进行了比较。为调查缺血性CP而进行的诊断性检查的实际总成本为42,476美元。如果以最具成本效益的方式进行检查，成本将为32,342美元，总共节省10,134美元。使用学生t检验比较了急诊科成本、计算出的成本效益成本和损失金额，发现它们之间的差异具有统计学意义（p<0.001）。使用卡方检验比较了有效性，发现具有显著性（χ(2)= 12.20，标准差 = 1，p<0.001）。
总之，在急诊科对缺血性CP进行快速有效的评估，并通过正确确定危险因素对患者进行正确管理可提供高水平的成本效益。每个急诊科都应确定针对CP入院患者的算法，医生应遵循此算法。
