The cost savings of the rural accelerated chest pain pathway for low-risk chest pain in rural general practice: a cost minimisation analysis
Rory Miller
1 * , Garry Nixon 1 , Tim Stokes 1 , Michelle Smith 1 , John W. Pickering 2 3 , Talis Liepins 4 , Martin Than 2
1 Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand.
2 Emergency Department, Canterbury District Health Board, Christchurch, New Zealand.
3 Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
4 Southern District Health Board, Dunedin, New Zealand.
Journal of Primary Health Care 15(1) 71-76 https://doi.org/10.1071/HC22117
Published: 21 December 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: The rural accelerated chest pain pathway (RACPP) has been shown to safely reduce the number of transfers to hospital for patients who present with chest pain to rural general practice.
Aim: This study aimed to estimate the costs associated with assessing patients with low-risk chest pain using the RACPP in rural general practice compared with transporting such patients to a distant emergency department (ED).
Methods: This was a retrospective cost minimisation analysis. All patients with low-risk chest pain that were assessed in New Zealand (NZ) rural general practice using the RACPP between 1 June 2018 and 31 December 2019 were asked to participate. The costs incurred by patients were determined by an online survey. Patients were also asked to estimate the costs if they would have been transferred to ED. System costs were obtained from the relevant healthcare organisations. The main outcome measure was the total cost for patients who present with low-risk chest pain.
Results: In total, 15 patients (22.7% response rate) responded to the survey. Using the RACPP in general practice resulted in a median cost saving of NZ$1184 (95% CI: $1111 to $1468) compared with transferring the same patient to ED.
Discussion: Although limited by low enrolment, this study suggests that there are significant savings if the RACPP is used to assess patients with low-risk chest pain in rural NZ general practice.
Keywords: chest pain, cost minimisation, cost of illness, diagnostic pathways, point-of-care, rural communities, rural general practice, transfer, troponin.
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