OBJECTIVES: This study aimed to evaluate the cost-effectiveness of outpatient follow-up after using the Chest Pain Choice decision aid (CPC-DA) compared to usual care in low-risk chest pain patients who presented to the emergency department (ED).

METHODS: A decision analytic model compared costs and effectiveness of the CPC-DA and usual care from a payer perspective. Effectiveness was based on published randomized controlled trial data comparing the CPC-DA with usual care across six EDs in the United States. Patients (N=898) presenting with chest pain and considered for admission to an observation unit for cardiac testing were included in the original trial. The model assessed 30-day probability of events and costs for outpatient follow up, ED-Observation Unit (ED-OU) admission, and cardiac events in and out of hospital. The measure of effect was defined as patients discharged to outpatient follow-up with no cardiac events. Costs reflect 2021 US dollars, and the incremental cost-effectiveness ratio (ICER) represents the cost per admission averted to ED-OU without cardiac events. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation were conducted.

RESULTS: The CPC-DA group yielded an expected cost of $3,917.58 and effect of 0.59 (i.e., 59% discharged to outpatient follow-up without a cardiac event), while the usual care group had an expected cost of $4,676.28 and effect of 0.40. The incremental cost of -$758.69 and effect of 0.19 indicates that outpatient follow-up stemming from CPC-DA is a dominant strategy compared to that from usual care. These findings were robust to sensitivity analyses.

CONCLUSIONS: The CPC-DA, designed to help patients and clinicians make a shared and informed decision regarding whether to be admitted to the ED-OU or discharged to outpatient follow-up for further cardiac testing and evaluation, can be cost-effective compared to usual care among low-risk chest pain patients presenting to the ED.