OBJECTIVES: Chest pain is the most common reason for emergency hospital admission yet only a minority of patients admitted to hospital ultimately have acute coronary syndrome (ACS). The Manchester Coronary Acute Syndromes (MACS) model is a validated clinical decision model that ‘rules in’ and ‘rules out’ ACS at admission using one blood test. MACS can potentially release economic benefits by preventing unnecessary admission and discharging patients home early. This feasibility study aimed to evaluate whether MACS represents a potentially cost-effective use of resources.

METHODS: An economic evaluation integrated into a randomised controlled trial compared (i) MACS guided care pathway (n=67) to (ii) ‘standard care’ pathway (n=65) with delayed (12 hour) troponin testing. Patients presenting to the emergency department at two hospitals with suspected ACS were included. In the MACS arm, clinicians were given patient’s risk of ACS and individualised treatment recommendations. An NHS perspective was used with a 6-month time horizon. Resource-use within hospital and follow-up was collected. Health status using the EQ-5D-3L was collected (baseline, 1, 3 and 6 months) and quality-adjusted life-years (QALYs) were calculated. Unit costs were collected from national sources (price year: 2016). Missing data were accounted for using multiple imputation (n=10 imputations).

RESULTS: Compared to SC, the MACS guided care pathway did not lead to a statistically significant increase in costs or QALYs. Incremental costs for MACs was £75 (95%CI: -£248.96 to £98.75) versus SC and incremental QALYs was -0.0025 (95% CI: -0.0183 to 0.0232) versus SC.

CONCLUSIONS: This feasibility study provides evidence on the use of MACS to guide clinical decision-making within the emergency department. There was no evidence of a change in QALYs or costs associated with MACS. Due to the small sample size, results on costs were sensitive to assumptions regarding missing data. Robust estimates on cost-effectiveness requires a larger trial.