Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Emerg Med J. 2023 Jun;40(6):437-443. doi: 10.1136/emermed-2022-212674. Epub 2023 Mar 14.
This 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.
State-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.
From 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.
Total 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.
本研究旨在估算澳大利亚维多利亚州因急性胸痛而就诊于救护车的直接医疗保健成本负担，并确定关键成本驱动因素，尤其是在低风险患者中。
这是一项针对澳大利亚维多利亚州连续成年急性胸痛患者的基于人群的全州队列研究，这些患者通过救护车就诊（2015 年 1 月 1 日至 2019 年 6 月 30 日），并与维多利亚州的急诊和住院数据进行个体链接。使用病例组合资金方法估算每个护理环节的调整通胀后的直接医疗保健费用（2020-2021 澳元）。
在研究期间，共有 241627 例因胸痛而就诊于救护车，胸痛发作的平均成本为 6284 澳元，总年度成本估计为 33740 万澳元（人均每年 68 澳元）。总年度成本在整个期间呈上升趋势（2015 年为 31050 万澳元，2019 年为 38450 万澳元），而平均发作成本保持稳定。心血管疾病（占就诊的 25%）是最昂贵的（平均 11523 澳元，总年度费用 14870 万澳元），而非特异性疼痛诊断（占就诊的 49%）是最便宜的（平均 3836 澳元，总年度费用 9340 万澳元）。被归类为心肌梗死、死亡率或住院风险低的患者（早期胸痛入院、心肌梗死和死亡率评分（ECAMM））占队列的 31%-57%，总年度费用估计为 6060 万-13540 万澳元，具体取决于使用的评分截断值。
急性胸痛就诊的总年度成本正在增加，而成本负担的很大一部分与低风险患者和非特异性疼痛有关。这些数据突出表明需要提高胸痛护理路径的成本效益。
