Rapid Access Chest Pain Clinics: An Australian Cost-Benefit Study

Rebecca Kozor; John Mooney; Harry Lowe; Leonard Kritharides; Mikhail Altman; Harry Klimis; Jay Thakkar; Dylan Wynne; Aravinda Thiagalingam; Gemma A Figtree; Clara K Chow

doi:10.1016/j.hlc.2021.05.106

Rapid Access Chest Pain Clinics: An Australian Cost-Benefit Study

Heart Lung Circ. 2022 Feb;31(2):177-182. doi: 10.1016/j.hlc.2021.05.106. Epub 2021 Jul 1.

Authors

Affiliations

¹ Royal North Shore Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: rebeccakozor@gmail.com.
² Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
³ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Concord Repatriation Hospital, Sydney, NSW, Australia.
⁴ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia.
⁵ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia.
⁶ Westmead Hospital, Sydney, NSW, Australia.
⁷ Royal North Shore Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.

PMID: 34217582
DOI: 10.1016/j.hlc.2021.05.106

Abstract

Objective: Chest pain is a large health care burden in Australia and around the world. Its management requires specialist assessment and diagnostic tests, which can be costly and often lead to unnecessary hospital admissions. There is a growing unmet clinical need to improve the efficiency and management of chest pain. This study aims to show the cost-benefit of rapid access chest pain clinics (RACC) as an alternative to hospital admission.

Design: Retrospective cost-benefit analysis for 12 months.

Setting: RACCs in three Sydney tertiary referral hospitals.

Main outcome measures: Cost per patient.

Results: Hospitals A, B and C implemented RACCs but each operating with slightly different staffing, referral patterns, and diagnostic services. All RACCs had similar costs per patient of AUD$455.25, AUD$427.12 and AUD$474.45, hospitals A, B and C respectively, and similar cost benefits per patient of AUD$1,168.75, AUD$1,196.88 and AUD$1,149.55, respectively. At least 28%, 26% and 29% of these RACC patients for hospitals A, B, and C, respectively, would have otherwise had to have been admitted to hospital for the model to be cost-beneficial.

Conclusion: This study shows that a RACC model of care is cost-beneficial in the state of NSW as an alternative strategy to inpatient care for managing chest pain. Scaling up to a national level could represent an even larger benefit for the Australian health system.

Keywords: Chest pain; Clinic; Economic evaluation.

MeSH terms

Australia / epidemiology
Chest Pain* / diagnosis
Chest Pain* / epidemiology
Chest Pain* / therapy
Cost-Benefit Analysis
Humans
Pain Clinics*
Retrospective Studies