Can Advanced Healthcare Technology Save Money?

In this issue of Circulation: Cardiovascular Quality and Outcomes , Hulten et al1 found that coronary computed tomographic angiography (CTA) may reduce hospital costs if emergency department (ED) patients with chest pain who are at low/intermediate risk of obstructive coronary artery disease (CAD) underwent coronary CTA,1 thus potentially saving hospitalization costs in patients with negative test results who could be promptly discharged from the ED. National hospitalization costs for noncardiac chest pain are not trivial. As an example, in 2011, the Centers for Medicare and Medicaid Services paid hospitals $526 million for hospitalizations classified into the chest pain diagnosis-related group2 (ie, patients who were ultimately found to have neither an acute myocardial infarction nor other acute coronary syndromes as the cause of their chest pain). A reduction in the frequency of such hospitalizations may result in substantial cost savings.Article see p 514Using sophisticated economic modeling techniques with detailed hospital cost data obtained from patients in the Rule Out Myocardial Infarction Using Computer Assisted Tomography (ROMICAT) trial, Hulten et al1 compared the actual costs of clinical care incurred by patients in the trial with the hypothetical costs these patients might have incurred if coronary CTA results were available to the patients’ clinicians (in reality, clinicians were blinded to coronary CTA results per the ROMICAT research protocol).1 The authors projected that coronary CTA would save hospitals—and, by proxy, healthcare payers—money only if it were used in patients with <30% risk of significant or indeterminate coronary stenosis.But in actual practice, will ED use of coronary CTA …