Strict application of NICE Clinical Guideline 95 ‘chest pain of recent onset’ leads to over 90% increase in cost of investigation

Rogers, Toby; Dowd, Rory; Yap, Hsiu Lye; Claridge, Simon; Fakih, K Al; Byrne, Jonathan

doi:10.1016/j.ijcard.2012.09.180

Cited by 8 publications

(6 citation statements)

References 4 publications

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“…Obstructive CAD was only confirmed in 23% of patients with a high PTP risk score and 9% in those with a moderate PTP risk score. 5 This may reflect a lower incidence of disease in our population, but more likely confirms that the PTP risk score overestimates the true risk. This has now been conclusively demonstrated in the international registry, CONFIRM, in 14,048 patients who underwent CCTA.…”

mentioning

confidence: 64%

“…Strict application of the current NICE guideline would result in substantial (42-93%) cost increase 5,19 because of patients with high PTP risk scores being referred directly for invasive coronary angiography. CCTA is a very fast test, both in terms of acquisition of the images and reporting; hence, its low unit cost per scan (£173) compared with stress echo (£236), nuclear scintigraphy (£293) and invasive angiography (£1052) based on the NICE costing report.…”

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confidence: 99%

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The evolving role of cardiac computed tomography angiography in an era of limited resources

2014

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confidence: 64%

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The evolving role of cardiac computed tomography angiography in an era of limited resources

2014

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“…Only the DFM and DCS models were studied in a letter to the Editor. The report on these models showed that by following the standard diagnostic pathway, the total cost of examining all patients was £102,731, compared to £198,495 for the diagnostic pathway proposed by the NICE chest pain guidance 32.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review

Liu

et al. 2017

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A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models. Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included. Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted. Ten studies involving the development of 12 models and two studies focusing on external validation were identified. Seven models were validated internally, and seven models were validated externally. Discrimination varied between studies that were validated internally (C statistic 0.66-0.81) and externally (0.49-0.87). Only one study presented reclassification indices. The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables. Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes. Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes.

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“…This was due to our previous studies which demonstrated that the NICE RS overestimated the risk of CAD. 6 However, this did not infl uence or bias our results as we compared the risk scores from two different guidelines and not their choice of investigation.…”

Section: Limitationsmentioning

confidence: 99%

“…5 Our previous studies demonstrated that the NICE RS overestimates incidence of disease. 6 Hence we have locally expanded the use of CTCA to patients with intermediate RS and the functional imaging tests to patients with high RS. Our aim in this study was to establish whether there is a difference between the ESC and NICE RS models.…”

Section: Introductionmentioning

confidence: 99%

Comparison of ESC and NICE guidelines for patients with suspected coronary artery disease: evaluation of the pre-test probability risk scores in clinical practice

et al. 2015

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The European Society of Cardiology (ESC) and UK National Institute for Health and Care Excellence (NICE) have recently published guidelines for investigating patients with suspected coronary artery disease (CAD). Both provide a risk score (RS) to assess the pre-test probability for CAD to guide clinicians to undertake the most effective investigation. The aim of the study was to establish whether there is a difference between the two RS models. We retrospectively reviewed records of 479 patients who presented to a UK district general hospital with chest pain between August 2011 and April 2013. The RS was calculated using ESC and NICE guidelines and compared. From the 479 patients, 277 (58%) were male and the mean age was 60 years. The mean RS was greater using NICE guidelines compared with ESC (66.3 vs 47.9%, 18.4% difference; p<0.0001). The difference in mean RS was smaller in patients with typical chest pain (13.0%). When we divided the cohort based on NICE criteria into 'high'-and 'low'-risk groups, the difference in the mean RS was 24.3% in the 'high'-risk group (p<0.001) compared with 2.8% in the 'low'-risk group. The UK NICE risk score model overestimates risk compared with the ESC model.

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Strict application of NICE Clinical Guideline 95 ‘chest pain of recent onset’ leads to over 90% increase in cost of investigation

Cited by 8 publications

References 4 publications

The evolving role of cardiac computed tomography angiography in an era of limited resources

The evolving role of cardiac computed tomography angiography in an era of limited resources

Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review

Comparison of ESC and NICE guidelines for patients with suspected coronary artery disease: evaluation of the pre-test probability risk scores in clinical practice

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