Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial.

OBJECTIVES The ESCAPE trial showed that chest pain observation unit (CPOU) care appeared to be cost effective compared with routine care. This finding may not be generalizable to hospitals that currently admit fewer patients than the trial hospital or that require higher direct costs to provide CPOU care. This study aimed to explore these issues in sensitivity analyses and develop a nomogram to allow prediction of whether a CPOU will be cost effective in a specific hospital. METHODS Data from the ESCAPE trial was used to populate a decision analysis model comparing CPOU with routine care. Sensitivity analyses examined the effect of varying the admission rate with routine care and the direct running costs of CPOU care following which the nomogram was created. RESULTS CPOU care provided improved outcome (0.3936 v 0.3799 QALYs) at lower cost (pound sterling 478 v pound sterling 556 per patient), with fewer patients admitted (37% v 54%). Mean cost of CPOU and routine care was pound sterling 116 and pound sterling 73, respectively, and of inpatient hospital stay was pound sterling 312. The mean post-discharge cost for CPOU and routine care was pound sterling 253 and pound sterling 309, respectively. Sensitivity analyses showed that CPOU care will not reduce costs at a hospital that currently admits fewer than 35% of patients, or a hospital that expects to incur direct CPOU running costs of pound sterling 60 per patient more than the trial hospital. CONCLUSIONS Findings of the ESCAPE trial are likely to be generalizable to most settings. The nomogram presented here can be used to predict cost effectiveness in a specific hospital.